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MedWorxs Solution Consultant

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MedWorxs was frustrated with complaints from our clients about poor customer service, processing errors and delays, and general feelings that our clearinghouse partners simply do not care.

We have fixed all this by bringing the clearing house process under our roof. We have created a state of the art, feature rich clearinghouse and interface which works in conjunction with the MedWorxs Practice Management System.

You will no longer need a separate contract with a clearing house or be forced to deal with substandard technical support. You will be able to count on the support from us at a level that outside vendors can never deliver on.

EDI - The Physician Network Solution
Allow your practice to dramatically improve productivity with secure real-time claims management solutions from MedWorxs.

Total Claims Management

• More than just a pipeline for claims
• Claims 'scrubbing' for clean submission
• Real-Time or batch claim status with messaging
• Real-Time or batch eligibility

Claims Follow-Up

• End lengthy and costly phone follow-ups tracking the status of your outstanding claims.
• Real-Time status inquiry to multiple claims instead of one at a time.
• Track claims by status – pending, rejected, paid….
• Filter claims by subscriber, physician, payer, status, batch and date
• View all claims status messages and edits per claim
• Total paperless administration

Rules Based Claim Management

Reduce rejected claims with the power and flexibility of the EDI rules based claim management.

• Table driven rules
• Testing rules by payer or practice
• Response rules for claim status
• Substitution rules by practice

Electronic Statements and Letters

Give your patients a more informative view of their payment responsibility using the EDI electronic 'patient due letter'. These letters are automatically generated when a claim status is due from the patient. Electronic statements will provide a view of all open encounters due from the patient.

• Automatically generate 'patient due letters' the day the claim balance is due from the patient
• Informative patient statements
• View statements online
• Add a message online to a statement
• Send recall and collection letters electronically

Clinical Claims Scrubbing

MedWorxs offers optional clinical claims scrubbing as a part of the EDI solution. The clinical claim scrubber verifies the technical and coding accuracy before your claims are filed by identifying potential problems that will cause claim rejection or reduction in payment.

The clinical claim scrubber provides a comprehensive set of coding and technical edits. Each individual edit may be enabled or disabled completely, for a specific claim type or for an individual payer. Some of these edits include:

• LMRP medical necessity
• Proprietary medical necessity
• RVU sequencing
• CCI/CCP
• E/M over/under coding
• Correct modifier usage
• ICD-9 validity, ultimate specificity, secondary code suitability and V-code validity
• CPT/HCPCS/ICD-9 current year validity
• CPT/patient gender suitability
• CPT/patient age compatibility
• Assistant surgeon rules
• Add-on/parent code resolution
• Medicare non-covered services
• Statutorily excluded services