Why Clemittance ?

Clemittance RCM and Billing system by Manteq is an end-to-end solution for healthcare facilities and providers that is used to streamline and manage all aspects of the Revenue Cycle and is designed to easily integrate with a broad range system and workflows through a set of Webservices and API’s.

Clemittance plays a substantial role in this cycle by supporting all coding standards (CPT, ICD, DRG…), and
offering different integrated components that cover all segments of the revenue cycle workflow starting from the patient registration, till the payment and settlement of the claims ensuring that all stages of the process are properly and efficiently handled such as the Medical Coding, Submission Management, Payment reconciliation and remittance processing, data validation and medical necessity checks. And easily visualizing this data using a smart BI engine designed primarily for the healthcare industry needs.

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Highlighted Features:

  • Claim processing: Clemittance will allow the medical coders to review claims, justify them, and make sure that they are meeting the coding rules and guidelines in a very simple and efficient user interface. The users can easily track changes on an individual claim and validate it through the validation engine ensuring that it is technically correct and is following the providers internal and contractual rules and guidelines.
  • Online Claim Verification: To help reduce rejections, Clemittance will allow users to submit the claims for online testing, report errors for each claim, and help users to fix the errors before actual submission.
  • Work Force Management: Clemittance is designed with the needed process and activities to maintain productive workforce, it helps supervisors and team leaders plan work responsibilities and duties, by matching employee skills to specific tasks over time, design team and work queues, and tracking results of the work efforts
  • Claim Submission and Batch Management: Clemittance support both individual claim submission as well as batch submissions, in both cases the users are not allowed to submit any unvalidated and approved claims, upon completing the submission claims change their status in Clemittance to prevent any changes ensuring the integrity of the data until Remittances advises are posted. The system will notify the users upon a successful submission and will provide summaries for each.
  • Remittances processing : Since Clemittance is fully compatible with the local post offices it continually monitors it checking for any posted remittance advises, and will auto downloaded it in real time bases and will map it to the claim and change it status down to the activity level based on the received response from the insurance company, it will also notify the users with the summary of this transaction to quickly begin the resubmission process if needed with minimum time and effort needed as compared to the XML manual process.
  • Manual Remit utility: is an embedded utility within Clemittance RCM designed to be used by team leaders and supervisors to correct any invalid posted remittances by the payers, the users can easily remap the claim with the corrected RA file and or use an external file to correct it.
  • Denial Management: upon usefully mapping the remittance to a claim the system will capture denials and helps the user in analysing trends and identifying key issues that resulted in these denials and clearly displaying the associated denial reason descriptions and codes, this will help make informed, knowledgeable actions within those rejected areas all while maintaining the full history of the claim in all its previous iterations both record and price wise.

Other Noteworthy Features:

  • Friendly user interface
  • Bulk actions
  • Notes and Attachment support
  • Claim Tagging
  • Up to date compliance with regulators
  • Cash Submission support
  • Test XML Generations
  • XML File Explorer with embedded reader
  • Manual or Batch Claim Creation via XML
  • User permission up to individual action level
  • Facility multi-tenant support
  • Microsoft azure security enabled
  • Manteq Validation Engine Support

The Contract Management Module provides the ability to manage contracts and master data in a central repository accessible by both the IT department and the Business. It is designed to enhance and easily manage contracting data of across all the Facilities as well as all clinical services provided by Healthcare entities. It allows you to standardize and streamline the contract structure and simplify the management and usage of the data sets provided by all user groups.

Key Features :

  • Building and managing master data (Clinicians Master, Insurance masters, Price lists)
  • Define Code types for both standard and Internal non-standard codes
  • Importing and Exporting data
  • Defining Insurances and TPA’S
  • Cash and Corporate Plan and Package Definitions
  • Insurance Policy definition
  • Insurance Contractual Agreement Management
  • Manage Exclusions
  • Easy to search and navigate contracts with a user friendly interface to manage data quickly
  • User control and freedom. Includes undoing and redoing previous actions

Clemittance is bundled with an E-Authorization Module that is fully compatible with the post office approvals and authorizations system, as well as the support for eligibility checks to validate whether the patient is an eligible member with the payer.

E-Authorization:

The system supports sending requests through two methods:

  • Order Level: through integrating with external 3rd party system on order level to obtain an approval for certain procedure or activity directly from within the HIS Interface and here, where a message will be sent the engine to which will create the requests and validate against the local and online validation rules, and will auto upload the request to the post office, after which the system will continuously monitor for the proper authorization file to automatically download and log it in both systems for later use in the claiming process .
  • Manual Requests: using the Clemittance User Interface, the users can easily create valid approval requests and upload them to the Post Office, after which the system will continuously monitor for the proper authorization file to automatically download and log it as well alert the users

Eligibility Requests:

The system supports running eligibility checks using the registration module of the system or through integrating the engine with a 3rd party registration module of an external system, in both methods the system will upload the request to the post office and push the response from the payer instantly with no delay and wait time.

 

Clemittance PBM Module was developed initially to help streamline the pharmacy approvals and claiming process. The PBM Engine can be integrated and called upon from many pharmacy systems or EMR System and / or used as a standalone system through the Clemittance PBM User Interface.

Key Features:

  • Can be used be used as standalone system or through an integrable Engine
  • E-Prescription Support
  • PBM Authorizations
  • PBM Claim Submission
  • Webservices and Standard APIs
  • Integrated with Clemittance Claim Management Module for Audits
  • Integrated with the Clemittance Business Intelligence Module and the interactive Dashboards