YEI ClaimScrub™: Comprehensive Claims Processing Suites

Yost Engineering is a leading provider of data services and back-end processing services for healthcare clients of every size, supporting up to 150M claims per month. We provide expertise and assistance for all of the claims processing data and systems that we provide and, in addition to our standard off-the-shelf claim scrubbers, can also efficiently customize a solution to meet any need.

Claims can be accepted in XML and standard ANSII X-12 formats, as well as raw data from billing and processing systems. Claims input formats can be configured to your system output specifications, and ClaimScrub response messages and processing results can also be customized if necessary to be compatible with your existing processing systems.

Summary of Benefits

Benefits for Providers:

• Identify and correct coding and claim issues prior to submission to payers, reducing claim denials
• Reduce claim turnaround time, reducing overall A/R days
• Reduce clearinghouse costs for rejected and resubmitted claims
• Edits updated on an ongoing basis, as frequently as daily, to ensure timely compliance
• Online access to YEI Policy Locator Provider WEB, allows quick coding research for timely claims editing

Benefits for Payors:

• Maintain industry-standard claims edits automatically, improving provider relations, and increasing accuracy of processed claims
• Build custom claims edits as necessary
• Reduce staff maintenance and review time
• Integrate with legacy systems, or supplement existing processing capability
• Ensure HIPAA-compliant transaction sets
• Historical edit profiles allow correct processing of older claims
• Edits updated on an ongoing basis, as frequently as daily, to ensure timely compliance
• Online access to YEI Policy Locator Payer WEB, allows quick access to research payment and edit questions
• Single YEI ClaimScrub server can process up to 1 million claims per day; servers can be chained to allow higher throughput, and load-balanced to maintain high responsiveness

Implementation, Hosting & Maintenance Options

YEI ClaimScrub can be added simply as a self-contained server appliance to existing networks. With internet access, we can directly maintain and update the data tables and/or configure the automatic update utility. Alternatively, we can provide the update files for clients to load themselves.

With either the web-based or server-based ClaimScrub systems, redundant servers allow fast recovery in case of equipment failure. Back-up power is provided to all YEI-hosted systems, and is also recommended for client-hosted systems. Full data back-ups and back-up verification are provided through redundant servers as well as off-site data storage. All data is fully encrypted, and access/change logs are maintained for all YEI-hosted databanks.

Pricing can be structured around per-claim rates, or around unlimited use models based on the number of modules in use.

YEI ClaimScrub™ WEB

In addition to the server-based ClaimScrub system, we also offer ClaimScrub WEB. ClaimScrub WEB offers the same options and flexibility as the traditional ClaimScrub service, plus:

• custom web interfaces and utilities, hosted by us or through your servers
• ActiveX components for easy integration of coding tools and reference data
• AJAX-based client web service (for a desktop application look and feel)
• TCP-IP-based query service
• Data validation services (batch and transaction modes)
• Full claims scrubbing systems (batch and transaction modes)

All solutions can be branded according to your specifications, and seamlessly integrated into your existing services.

YEI ClaimScrub™: Components and Modules Options

YEI ClaimScrub can be set up as a comprehensive claim scrubber checking all claim data against a large library of maintained industry-standard or custom edits. It can also be configured to provide only the specific modules or data checking required, as a stand-alone system, or as a supplement to other claims processing systems that lack functionality in certain areas.

YEI ClaimScrub can also serve as a bridge between non-compliant legacy processing systems, and HIPAA-standard transactions.

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