Insurance Contract Management
With 95% of patients being covered by insurance, it's imperative that Healthcare Providers have a very elaborate contract management system that can capture and configure all the variable rules around each of the rate card and ensure that all the rules configured are automatically complied with.
The rules around the contract and rate card of each Receiver-Network combination are too complex to manage manually based on human intelligence. Lifetrenz RCM System ensures compliance to each of these billing rules, and also handles variables and exceptions to these rules.
Insurance Contractual Configurations
Lifetrenz RCM is a new generation System with complete contractual management capability, which ensures that all the billing rules and processes are automatically complied with and helps to drastically bring down claim denials and write-offs. With Lifetrenz System, your dependence on the competence or individual heroics of employees to manage your Contractuals and Revenue Cycle is totally taken away.
Lifetrenz RCM System is built with detailed and precise contract management tools to ensure that all scenarios of insurance receiver - contract terms, are configured and managed by the System. The capability of contract scenarios includes configuring a ‘Rate Card’ for each ‘Receiver - Network’ combination.
For each ‘Rate Card’, the System has the capability to configure the following:
- Mapping the Insurance Payers to the Receivers.
- Mapping the Standard Expiry of an authorization.
- Mapping ‘Pre-Approval’ limits and Exclusions on services/activites for ‘Pre-approval’.
- Further configuring if the ‘Pre-Approval’ is inclusive of deductions & co-pay or not.
- Exclusions can be configured for Items or Type of Consult (Dental/maternity).
- Configuring ‘Priority Patient’ rules for VIP Patients, for which services beyond the agreed rate card would be offered at self-pay rates.
- Capability to maintain versions of rate cards with effective dates.
While adding charge items/services to a rate card, the following configuration and flexibility
is available, for each item in a rate card:
- Creating co-pay service groups (items grouped to handle different co-pay by group – e.g. lab, radiology etc.).
- Override the default code-set (CPT 2012, DSL, HCPCS etc.) and code, for a specific item for a specific rate card.
- To be able use DDC price or a percentage (%) of the DDC price for in-clinic medications.
- To configure a variable price for an item/ service in a rate card (E.g. health check packages).
- To mark items that needs to go for ‘external claims’ (E.g. Some lab tests for certain receivers can be ordered, but the claim must be submitted by the partner Lab and not by the provider clinic). Only administration charges are collected from patient for these services by the provider clinic.
- Or, mark that if a particular item, if included in the doctor's order, will mandatorily need ‘Pre- Approval’ (Item exclusion on ‘pre-approval’ limit for the rate card).
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For a description of some of the important processes covered in our RCM, please click on the links below
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Revenue Cycle Management
The most powerful and automated Contract Management and Revenue Cycle management system in the region, can help you achieve Zero Denials, increased revenues and faster revenue realization...
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RCM in Clinic Workflows
Attempting to manage claim denials after the event, is costly and causes unnecessary delays in revenue realization. Depending purely on the Medical coding team post the consult is not the most effective way...
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Insurance Contract Management
With 95% of your patients being covered by Insurance it is imperative that you have a very elaborate Contract management system that can capture and configure all the variable rules around...
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Claim Processing
Lifetrenz RCM module is a New generation solution, the RCM maintains Separate Workflow Queues and maintains the Stages of a case within each Queue. The Queues maintained are for ePrescription,...
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AR & RA Reconcilliation
The Lifetrenz RCM solution has an elaborate Accounts Receivable module to Manage all account receivables and reconcile Remittance Advice from insurance payments.
When the bills are Finalized in OP DNFB... -
eJADA Compliance
With over 17 eJADA parameters to mandatorily submit in your eClaim XML, the Lifetrenz Clinic Management ensures that the doctor Captures all mandatory parameters and the Lab results mandated for the captured Diagnosis...
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eSource Reports
Dubai Statistics Center (DSC) has mandated 19 reports in two parts (emirati and non emirati) to be submitted monthly or annually. Lifetrenz Clinic allows you generate these report in the prescribed template format from the system...
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Request a Demo
If you are a decision maker at a Healthcare Facility, and would like to see a Demonstration of any of our Products for the Healthcare Vertical, We would be keen to demonstrate the same. See all the workflow and processes at you clinic in a demo.