ProClaim Partners New HETS/CLIP/DDE Module Delivers Integrated Access to Medicare Eligibility Determination and Claims Management Tools

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Real-time eligibility determination and claims management, available through a seamlessly integrated, enterprise-class CLIP/HETS/DDE module, saves time, improves workflow, and accelerates revenue collection.

“We are proud to offer this dynamic, user-friendly CLIP/DDE and HETS module as an integral part of our ProClaim clearinghouse portal,” says Mr. Jim Hoey, President.

Proclaim Partners, LLC, the leading developer of an enterprise-class Medicare and third party claims processing web portal for post-acute care providers, announces the availability of its much anticipated new Medicare Claims In Process (CLIP) module integrated into its acclaimed DDE/HETS module. The complete module incorporates a suite of tools to smoothly navigate Medicare eligibility and claims processing tasks in ProClaim, the easy-to-use Software-as-a-Service third-party eligibility, claims processing, and reimbursement solution. This module raises the bar on usability, claims workflow processes, and secure claims data management through each stage of the Medicare claims management lifecycle. Combined with the other powerful ProClaim clearinghouse claims aggregation, processing, transmission, and reporting tools, the new module helps providers accelerate payments, increase collections, reduce DSO, and dramatically increase claims management staff productivity.

The new integrated CLIP and DDE/HETS Module provides four convenient software services: 1) the browsing of claims data from its ProClaim proprietary web user interface, 2) a secure, high speed connection between the portal and the Centers for Medicare and Medicaid Services (CMS), 3) an integrated implementation of the new HIPAA Eligibility Transaction System (HETS) for real-time eligibility determinations, and 4) Claims-in-Process (CLIP) which securely sweeps the CMS data during off hours for the latest claims activities. The data seamlessly integrates into the ProClaim database and workflows. Together these functions will present the CMS data in a much more user-friendly, browser-based format.

“Without ProClaim, payers, providers, and healthcare ISVs face increasingly difficult tasks when it comes to submitting, monitoring, and receiving Medicare payments,” comments Jim Hoey, the founder and President of ProClaim Partners. “The third party terminal emulation software which providers have used to access the CMS DDE system has fallen far behind the pace of multiple software operating systems and browser releases.” Mr. Hoey further explains that new claims management specialists also face the daunting challenge of learning and using one of the oldest mainframe-based claims processing systems still in operation. Meanwhile, CMS has introduced new real-time eligibility determinations standards. “This forces providers to use modern internet technologies to determine initial eligibility for every Medicare claim,” Mr. Hoey continues. While CMS has recently delayed the sunset date for access to the older, non-real-time Common Working File (CWF) technology used for eligibility determination, the transition to HETS is still imminent. “Providers should transition sooner than later. Ninety days may not be long enough.”

Working closely with its customer base and healthcare claims management experts, Proclaim Partners has responded to this challenging Medicare claims processing environment by designing, developing, and deploying the new CLIP/DDE/HETS module. “We are proud to offer this dynamic, user-friendly CLIP/DDE and HETS module as an integral part of our ProClaim clearinghouse portal,” says Mr. Hoey. “Our customers and post-acute care customers and contacts have eagerly anticipated its release.”

About Proclaim Partners
Designed for post-acute providers, the ProClaim Partners automated claims clearinghouse solution enables timely and accurate claims processing, making healthcare claims management easy. ProClaim delivers a user-friendly, enterprise-class web portal to help providers successfully manage the healthcare claims lifecycle to accelerate payments and reduce DSO. Providers can stay on top of their Medicare, Medicaid, and commercial claims from eligibility determination to submission to processing to payment in real time.

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Rand Johnson
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