Payor Solutions

RevenueMD payor solutions offer powerful tools for automating claims adjudication and remittance processing, reducing overhead costs and improving provider relations.

Claim Editing
RevenueMD Claim Editor gives health plans, TPAs and government payors the ability to rapidly and precisely identify and eliminate incorrect and incomplete claims before they enter the payor’s system, eliminating adjudication costs for claims that cannot be paid.

Advantages include:

• Huge library of industry standard edits

• Fully customizable edits with no programming required

• Decreases re-submissions, suspense and false accepts processing

• Increases claims processing staff productivity

• fast and complete feedback to provider improves relations

Physician Solutions
RevenueMD offers physicians cost-effective, user-friendly solutions that can eliminate eligibility losses, minimize claims resubmissions and allow electronic routing to most payors.

Eligibility

Approximately 6% of all healthcare claims are denied due to ineligibility. Most of these are impossible to recover and result in financial loss. RevenueMD™, our online eligibility product, provides these features:

• Determine a patient’s eligibility before service is provided

• Obtain results within seconds over a secure web browser, eliminating wasted staff time on 1-800 calls

• Single or multiple patient requests - an entire patient schedule can be processed within minutes

• Decodes and organizes payor information into plain English

The result is a significant reduction in unrecoverable claims denials and losses.

Claim Editing

Approximately 25% of all healthcare claims are denied due to claim preparation errors. There is no value to a claim that is accepted for adjudication and ultimately denied. Competitors determine success based on claims a payor accepts for review. At RevenueMD we understand that your revenue is based on claims a payor not only accepts for review but pays. 

Our exceptional RevenueMD™ claim editor increases payment rates as never before. RevenueMD uses payor-specific edits to make sure that the claim is paid on first presentation, nearly eliminating resubmissions. Within seconds, RevenueMD identifies every reason that a claims file may not be paid based on all CCI/LMRP/medical necessity edits as well as published and unpublished payor-specific criteria which are updated weekly.

RevenueMD’s all-payer rules engine delivers unprecedented performance, allowing providers to:

• Achieve 100% payment rate for reimbursements on first submission.

• Slash receivables and days outstanding by up to 20%

• Accelerate revenue collection

• Reduce denial management costs

• Improve work processes by identifying needed data collection improvement

Claim Submission

RevenueMD Submit is a service available to users of our RevenueMD claim editor and allows error-free claims to be submitted through our all-payor clearinghouse with the click of a mouse from the RevenueMD window. 

Advantages include:

• Clean claims automatically submitted

• Secure, electronic claims submission over an internet connection

• Automatic data formatting for every supported payor

• Seamless connectivity to commercial and government payors

• Bundled pricing offers cost effective alternative to other clearing services

Hospital Solutions


Our revenue management solutions for hospitals and other healthcare facilities focus on three important concepts:

• Determine eligibility before service is provided

• Submit error-free claims that will be paid when presented

• Simplify clean claim submission with a “one-click” electronic solution

Eligibility

Approximately 6% of all healthcare claims are denied due to ineligibility. More than half are impossible to recover and result in financial loss. Our RevenueMD online eligibility product allows providers to determine a patient’s eligibility before service is provided, within seconds over any web browser. RevenueMD supports single or multiple patient requests in real time or batch. Payor information is decoded into plain English. An entire patient schedule can be processed within minutes. The result is a significant reduction in unrecoverable claims denials and write-offs.

Claim Editing

Approximately 25% of all healthcare claims are denied due to claim preparation errors. There is no value to a claim that is accepted for adjudication and ultimately denied. Competitors determine success based on claims a payor accepts for review. At RevenueMD we understand that your revenue is based on claims a payor not only accepts for review but pays.

Our exceptional RevenueMD claim editor increases payment rates as never before. RevenueMD uses payor-specific edits to make sure that the claim is paid on first presentation, nearly eliminating resubmissions. Within seconds, RevenueMD identifies every reason that a claims file may not be paid based on all CCI/LMRP/medical necessity edits as well as published and unpublished payor-specific criteria which are updated weekly.

RevenueMD’s all-payor rules engine delivers unprecedented performance, allowing providers to:

• Achieve 100% payment rate for reimbursements on first submission.

• Slash receivables and days outstanding by up to 20%

• Accelerate revenue collection

• Reduce denial management costs

Coming soon: RevenueMD Denial Analytics Module™ will improve work processes by providing statistical and qualitative claims denial data used to identify information collection deficiencies and needed organizational improvements.

Coming soon: RevenueMD interface to top institutional billing systems will permit edits to be performed in RevenueMD and automatically corrected in most systems.

Claim Submission

RevenueMD Submit is a service available to users of our RevenueMD claim editor and allows error-free claims to be submitted through our all-payor clearinghouse with the click of a mouse from the RevenueMD window.

Advantages include:

• Clean claims are automatically submitted

• Secure, electronic claims submission over an internet connection

• Automatic data formatting for every supported payor

• Seamless connectivity to commercial and government payors throughout the U.S.

• Bundled pricing offers cost effective alternative to other clearing services