Charge entry & claims processing
Medical Billing and Claims Processing Support
Two jobs that are usually treated as one. Charge entry decides whether the claim is right; claims processing decides whether it gets paid. We run both against your rules, and we keep the boundary between what we validate and what your clinical team decides absolutely clear.
What we handle
Charge processing and coding-data validation support, based on client-provided documentation and established workflows.
- Charge entry and charge validation
- CPT and HCPCS data processing
- Diagnosis code data processing
- Modifier application against your documented rules
- Date-of-service validation
- Rendering and billing provider information validation
- Place-of-service validation
- Batch charge processing
- Charge reconciliation against the encounter list
- Claim creation support
- Claim validation against payer edits
- Electronic claim submission support
- Paper claim processing support
- Clearinghouse rejection identification
- Claim status tracking
- Claim correction support
- Resubmission and reconciliation
Your queues, your system, the same people on them every day.
How the work runs
Charges are reconciled before anything is submitted, so a missing encounter is found while it is still a missing encounter.
- 01Receive
- 02Validate
- 03Reconcile
- 04Submit
- 05Track
- 06Correct
Charge Entry
The claim is decided here. Everything downstream is either collecting on a correct charge or arguing about an incorrect one.
Deeva provides charge processing and coding-data validation support, based on client-provided documentation and established workflows. We do not perform independent clinical coding, and we do not assign codes that are not supported by the documentation you provide.
- Charge entry from client-provided documentation
- Charge validation against your fee schedule
- CPT and HCPCS data processing
- Diagnosis code data processing
- Modifier application against documented rules
- Date-of-service validation
- Rendering and billing provider validation
- Batch charge processing
- Charge reconciliation against the encounter list
- Missing-charge identification and escalation
Claims Processing
Submission is the easy part. The work is what happens to the claims that do not go straight through.
- Claim creation support
- Claim validation against payer and clearinghouse edits
- Electronic claim submission support
- Paper claim processing support
- Claim status tracking
- Rejected claim identification and categorization
- Claim correction support
- Resubmission
- Submission reconciliation against the charge batch
- Escalation of claims that stop moving
What you get
- A reconciled batch, not just a submitted one
- Charges entered are reconciled against the encounters expected, so a missing day is visible the day it goes missing.
- Rejections categorized, not just reworked
- Every rejection is coded to a reason, so the same edit does not keep catching the same claims.
- A documented rules file
- Your modifier rules, payer quirks and exceptions written down during transition and maintained, rather than held by whoever has been there longest.
- A clear line around coding
- We validate against your documentation. Anything the documentation does not support comes back to you rather than being guessed at.
Reporting cadence
- Daily
- Charges entered, claims submitted, rejections worked.
- Weekly
- Rejection categories and anything that needs a rules change.
- Monthly
- First-pass quality and turnaround against the agreed measures.
How it is measured
KPIs and SLAs are customized according to the client's process requirements and contractual scope.
These are the measures we report on. The targets against them belong in your agreement, where they can be negotiated and enforced, rather than on a web page where they cannot.
- Charge entry accuracy, sampled at transaction level
- Charge lag from date of service
- Charge reconciliation completeness
- Claim processing turnaround time
- First-pass acceptance
- Rejection rate by category
- Correction and resubmission turnaround
- Process compliance against the SOP
- SLA compliance
Find out where your clean claim rate is leaking
Send us your current volumes, your clearinghouse rejection categories and your payer mix. We will come back with a delivery model, a team structure and a transition plan.