eClaim Solution: Insurance Discovery Solution for Ambulatory Services in USA

Ambulatory services play a vital role in transferring patients to and from healthcare facilities, providing continuous care during transit. An ambulance typically carries essential equipment and supplies, including stretchers, defibrillators, oxygen, medical drugs, and various other life-saving tools.

During ambulance transportation, patients may not be able to provide their demographic and insurance information to the crew for documentation and record creation. Collecting patient and insurance details is crucial for claim processing. Several factors can contribute to missing or incomplete data, such as:

• Incomplete or missing insurance demographic information
• Lack of awareness about insurance details
• Failure to provide insurance information due to circumstances
• Patients not providing insurance information during the service
• Patients opting for self-pay due to unawareness of insurance coverage

The primary focus of the ambulatory crew is to save and stabilize the patient, leaving less time to collect detailed information. Once a patient is transferred to a healthcare facility, the crew moves on to the next call.

To address this issue, we have developed the Insurance Discovery software—a cutting-edge solution created by healthcare experts and advanced technology. This tool utilizes 15 algorithms to retrieve insurance demographic data and can update the algorithms based on insurance outcomes. It offers a perfect solution for ambulatory services.

By entering a few patient demographic details, the Insurance Discovery tool can retrieve current active insurance information. The tool’s intelligent programming also provides Co-Ordination Of Benefits (COB) information if the patient has multiple active insurance coverages. Selecting the correct insurance coverage enables the billing office to file claims accurately, reducing errors caused by coverage discrepancies or missing information. The faster reimbursement of claims helps the Centralized Billing Office (CBO) maintain a reduced AR days (DSO – Daily Sales Outstanding), demonstrating best practice.

Identifying the responsible insurance carrier correctly prevents claims from being categorized as private pay or self-pay patient responsibilities. Collecting outstanding payments from patients can be challenging compared to dealing with insurance payers. Sometimes, failure to identify the correct payor and lack of response from patients result in potential reimbursement write-offs.

The Insurance Discovery tool offers the best solution when the ambulance crew can only gather basic patient details from identification cards. Even if the initial information is insufficient, the back office can retrieve patient and insurance demographic information accurately using the Insurance Discovery tool.

We are proud to provide this efficient and reliable solution to ensure seamless operations and accurate billing in ambulatory services.