MatrixCare claims management functionality is a revenue-maximizing game changer

Written by: Amy Ostrem, Senior Product Manager, MatrixCare

At MatrixCare, we offer an outstanding Claims Management experience. We have guaranteed results and a proven Return on Investment that speaks volumes to those more unfortunate billers who are stuck working with a wide variety of our underperforming competitors in this industry. I continue to hear from our prospects the nightmare they have working with each payer’s website or constantly uploading files of claims and remits here and there to complete their revenue cycle management process. To highlight 3 key areas that put the “O” in being “O”outstanding at claims, we will focus on:

  1. Automated Workflow
  2. Claims Management Statistics
  3. Advanced Available Features: Automated Secondary Billing, Denial Management, and Claims Management Acuity Analytics

#1. Automated Workflow is a key differentiator. Why?

Talk about time savings and ease of use! With MatrixCare Claims Management, you save time since claims created arrive seamlessly into Claims Management where payer-specific edits are applied prior to claim transmission. There is no need to create files of claims and then browse and upload them to the payer. And, likewise, for 835 remits, once these are issued, they arrive seamlessly into Claims Management and into the MatrixCare dashboard immediately alerting your cash experts to complete the automated distribution process. It’s a fact that new clients who utilize the MatrixCare Claims Management process and 835 remit auto distribution process are seeing an 80% reduction in time spent posting cash!

#2. Claims Management Statistics are larger than ever! Did you know:

  • MatrixCare clients transmit over 415,000 claims per month
  • Electronic Connectivity is available to over 2,000 payers and grows weekly
  • Our Claim Acceptance Rate month to month is consistently above 94% (that’s an A)!
  • A team of over 30 people at Change Healthcare are dedicated to monitoring payer regulatory changes and managing updates to the editing process as a result

#3. Advanced Available Features. Tell Me More:

Automated Secondary Billing, Denial Management, and Claims Analytics, OH MY!

Thanks to the advanced features embedded with our selected clearinghouse, we provide you the ability to automatically secondary bill your claims. Immediately after we receive an 835 from any payer that indicates a crossover did not occur, our system creates the secondary claim for you automatically using the original claim and remittance data so all of the necessary information gets populated for correct and accurate payment. This process can not only save you time, but clients who utilize the automated secondary claims features are experiencing a cash flow improvement of up to 10 business days.

Denial Management is something that not all organizations find easy to tackle, but with MatrixCare Claims Management, you can configure the dashboard to call out and consolidate denials by denial reason codes allowing you to analyze the reasons you may not have been paid and to take action to improve your process for the highest revenue potential reasons first. The embedded exception-based workflow allows you to focus on only those claims that need attention first. The ability to look across all lines of business at denials and denial reasons is so powerful, that some of our clients are assigning claims with specific denial reasons to specific billers who have specialized in addressing these particular types of denials. And with the configurations in Claims Management, this workflow is handled with ease and automation.

Claims Management Acuity Analytics has made an impact on clients with both a small and large number of facilities submitting claims and here’s why:

  • It provides over 1,500 data elements of claims and remit data to create reports on which is THE BEST standardized source of overall clinical and financial data (not to mention it’s also the claims data that CMS is tracking)
  • You can analyze the performance of both payers and employees
  • It includes dashboards and trending which answer questions:
    • Which payers are your worst performers who are having the highest revenue impact?
    • Are my payers performing to standards agreed upon in the terms of our contracts?
    • What are denied claims costing your organization?
    • Are you handling managed care billing well?

MatrixCare continues to have a strong partnership with our clearinghouse provider, Change Healthcare, for 17 years. Together, we continue to navigate regulatory changes and industry challenges. We meet regularly and share the same passion for ensuring and maximizing cash flow and reimbursement for our clients.

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Amy Ostrem

Amy Ostrem, Vice President, Strategy & Portfolio Management, has been working with our products and service teams for more than 2 decades. She originally was a client before joining the company as a Client Education Consultant and has served in various departments and roles through her tenure. In her current role, she divides her time between client communications, client service teams, sales enablement, and product development teams. Ostrem oversees the Product Strategy, Value Proposition, Commercialization, Product Managers, and Business Analysts. She participates in industry events, client engagement sessions, focus groups, our annual Inspire event, and presents regularly at provider advisory boards. Ostrem holds a bachelors degree from Concordia College in Healthcare Financial Management.

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