Revenue Cycle Management

Chenoa has implemented rules and workflow based accelerator for Revenue Cycle Management (RCM) which includes Claims Adjudication engine helping Payer and TPAs in processing healthcare claims and adjudicating them for denials and payments. With inbuilt pre-defined 1000s of rules and edits, the adjudication engine can accurately perform business validations on the claim and determine the outcome.

In addition to the above, RCM also includes the Denial Management engine for Providers which can handle incoming 835 EDI files and initiates workflow based on the denial/rejection codes received through skill based routing intelligence. RCM also includes Eligibility and Benefits (E&B) verification interface which can integrate with any Payer database or 3rd party E&B service providers (e.g. Availity) through 270/271 EDI transactions and determine patient eligibility for the given service, and patient’s benefits like co-payments, deductibles and out of pocket costs. Eligibility and Benefits verification interface can be applied to pre-submission claims processing (Clean Claims), Pre-authorization engine and Claims adjudication engine (post-submission).

Platforms for Revenue Cycle Management

Aggregating disparate data sources into one location along with data management services to allow your organization to gain insight into different facets of your business

ONC HIT 2014 certified BI/analytics platform that provides healthcare organization executives with the necessary tools and resources needed to gain a better understanding into patient population data and deliver cost effective, compliant and quality healthcare services in a timely and cost-effective manner

Scanning your 837 files before being sent to your clearing house so your coders can edit claim line errors on the fly