UMCET Applications : Applications

Claims Manager

Claims Manager is our claims compliance scrubber. When charges have passed through the transaction editing system (TES), the Claims Manager application performs an extensive review of patient charges.

Benefits realized

  • Ensures each charge and its required data is complete
  • Ensures billing meets Federal and State guidelines prior to submission for third party reimbursement by continually researching third-party industry sources and resources to improve the accuracy and efficacy of coding relationships and edits within the Claims Manager Knowledge Base
  • Utilizes information from Local Coverage Determination (LCD), National Coverage Decisions (NCD), and provider specialties for the diagnosis related edits cross reference CPT and HCPCS codes (excluding unlisted codes) with commonly associated ICD-9 diagnosis codes.