Finding visits that happened and never became a claim
A denial at least proves something went out. This failure is much quieter, because no claim exists for anyone to deny: a note left unsigned so no charge was ever created, or an appointment marked complete on the schedule while nothing was ever set complete in the chart. The sweep is a join between what the schedule says happened and what the ledger says was charged, run over a window long enough to catch stragglers and short enough to stay inside the filing limits of the slowest payer.
Electronic eligibility answers whether a patient is covered, and then somebody opens the payer portal anyway to find out what is actually payable.
There is a mandated electronic standard for eligibility, and it works. It confirms that a plan is active. What it routinely omits is the detail the front desk actually needs: frequency limitations, waiting periods, alternate benefit provisions and remaining annual maximum. That gap is the origin of most manual verification in this sector.
- athenahealth
- eClinicalWorks
- Open Dental
When this is the wrong thing to build
Pick something else if checkout already requires a completed chart before the patient leaves the building, or if somebody reconciles the day sheet against the schedule every evening, in which case the sweep confirms what is already known and adds a report nobody opens.
The constraint that shapes it
A practice is a covered entity, and any vendor that creates, receives, maintains or transmits protected health information on its behalf is a business associate, which requires a written agreement in place before any disclosure. More on how this sector works.
No alarm goes off when a thing simply stops arriving. Read what this shape is, or start from one of these.
- Noticing that an agent licence has quietly lapsed
- Watching an MLS feed for the day it goes quiet
- Catching a lapse date nobody put on a calendar
- Closing the registration window before it closes you
- Scheduling the visits a membership already promised
- Closing the permit that never got its final inspection
- How do I find appointments that were never billed?
- What is a missing slip in athenahealth?
- Why do some visits never generate a claim at all?
- How do I check for unsigned notes holding up billing?
- How far back should I look for unbilled procedures?
Back to medical and dental practices, or see how this is priced and scoped.