ProClaim®

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EXCLUSIVELY WITH ProClaim®,
VERIFYING YOUR CLAIM’S STATUS
IS NOW EASIER THAN EVER

Our constant pursuit of innovation has led us to integrate ProClaim with the capacity of requesting the status of any claim in real time, with NO need to call the health insurance company.

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Medical Offices/Facilities

ProClaim® is Puerto Rico’s fastest growing billing system, offering the highest level of satisfaction in the industry. ProClaim® has become the preferred system among medical and dental facilities in Puerto Rico. Today over 2,500 providers process their claims through ASSERTUS and our billing system, ProClaim®.

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The fastest growing billing system with the highest client satisfaction in the industry is now available to dental facilities.

ProClaim® manages the entire billing cycle for dental health providers, from the moment a patient receives an appointment to the moment payment is received for services rendered.

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Health Centers

Using our billing system ProClaim®, Health Centers in Puerto Rico have achieved an integrated and efficient billing process for all services offered within their facilities including, medical, dental, laboratories/labs, X-Rays, ambulance, vaccination and others.

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Billing Agencies

ProClaim® is the preferred billing system of billing agencies in Puerto Rico. Many leading billing agencies have migrated to ProClaim® due to the efficiency and positive results they achieve which subsequently translates into increased benefits for their clients, the health providers.

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EHR/EMR Integration

ProClaim® conveniently integrates with your Electronic Health Record system (EHR/EMR). This integration between ProClaim® and your Electronic Health Record allows information exchange between both systems in a safe and transparent manner. Through this integration the systems share patient appointments, patient demographic information, and the doctor-patient encounter as documented by the health care provider in order to generate the corresponding claim.

PROCLAIM-LogoWith ProClaim® you achieve maximum efficiency and debt collection…

ProClaim is the most advanced billing and administration system for medical facilities in Puerto Rico.  It was developed in Puerto Rico and counts with every tool necessary for empowering the medical professional to face and overcome the daily challenges produced by the billing process.  ProClaim is the first Practice Management System that includes all the features of a billing system integrated with Clearinghouse services.  All of this is achieved without the need for an external component to send and receive electronic transactions, or to simply verify a claim’s status.  Your billing system never loses control or contact with any claim submitted to the health insurer.  The status and follow up of every claim is always available in your billing system.

ProClaim® Step by Step...

Step #1 – Patient Appointments

An efficient billing process starts with an efficient patient appointments module.  ProClaim® counts on an extremely flexible appointment module which essentially adapts to any health facility.  The system allows for the creation of multiple appointment books for providers, departments or services that require control of an electronic appointment system.  Users can adjust patient limits, services per day, office hours, holidays, and more.  One of the most versatile features of ProClaim’s appointment module is its capability to verify patient eligibility with a simple click of a button.  This is incredibly helpful in identifying those contracts that are not active even before patients arrive at the office.

Step #2 – Eligibility

Thanks to the integration between ProClaim® and the ASSERTUS clearinghouse patient eligibility can be completed in a couple seconds using the information already registered in the billing system.  This makes the process quicker and much more efficient for two main reasons.  First, because users don’t have to input information in another system or web page in order to determine eligibility.  Secondly, by verifying eligibility directly from the billing system, we make sure the registered information is correct.  Besides knowing patient eligibility, depending on the medical insurance, users can find additional patient information such as, to what Advantage health plan they belong, annual deductibles, coverage, demographic information to complete record, among others.  The eligibility does not have to be printed because ProClaim keeps a complete record of patient eligibility, attached with corresponding claims, in case it needs to be printed in the future.

Step #3 – Demographic Record

The demographic record is the patient control center, where users gather and validate basic information.  Additionally users have access to a complete record of claims, services rendered to the patient, eligibilities, digitalized documents and others.  At the moment a patient is being registered, the system provides certain controls to avoid commonplace errors that take place when inputting data.  These controls help avoid data duplicity and possible claim rejections.

Step #4 – EHR/EMR Integration

ProClaim® integrates with the vast majority of Electronic Health Records(EHR/EMR) through the communication protocol Health Level Seven (HL7) and others.  This prevents double entry of data, which in turn results in greater integration and consistency for the information stored in both systems.  Typically the system integrates the patient’s demographic data, the appointment and its pertaining information in order to generate the claim for services provided.

*VERIFY WITH ASSERTUS IF YOUR EHR/EMR SYSTEM INTEGRATES WITH PROCLAIM®

Step #5 – Billing

The key to efficient billing is making sure it’s produced correctly from the beginning.  With that in mind ProClaim® provides a series of validating checkpoints throughout the billing process, geared towards preventing common errors during data entry and coding.  Additionally it provides “quick fix” option in case of rejection.  ProClaim® also provides efficient managing of complementary, supplementary and secondary health plans.  The delivery and reception of all electronic transactions are done through ProClaim® thanks to its integration with the ASSERTUS clearinghouse.  This includes eligibility request and response (270/271), claim delivery, reception of acknowledgment of receipt, claim application status(276/277) and the reception of explanation of payments.  Transmissions can be carried out from any work station within the medical facility for users with the appropriate access.

Step #6 – Automatic Audit - Acknowledgment of Receipt

ProClaim® and Claim Control® technology automatically standardize and analyze each Acknowledgment of Receipt in order to identify rejections in the early steps of the billing process.  The system automatically follows up on every claim until receiving acknowledgment of acceptance from the medical insurer.  All of this occurs without having to exit your billing system.  ProClaim conducts an automatic audit of the acknowledgments of receipt, and as a result the system clearly identifies returned claims due to errors and claims without an acknowledgment of receipt.  This way we avoid “missing in action” claims.  With ClaimControl® technology there is no need to print Acknowledgments of Receipt to process them manually, ClaimControl® does it for you. 

Step #7 – Automatic Reconciliation

ProClaim® offers a true automatic reconciliation for explanations of payment, received electronically from the health insurers. The system allocates the payment received from every claim and automatically detects any discrepancy between what was billed and the payment itself. If any difference is detected, the system automatically generates the original adjustment form of each health insurer.  In case of complementary Medicare health plans, the system automatically generates the CMS-1500 form attached with the payment explanation regarding that specific claim.

ProClaim® is more than...

Objectives and Results

  • Increase debt collection percentage (%) /  Reduce accounts receivable
  • Diminish processing time when generating and following up on claims
  • Diminish rejections and adjustments
  • Achieve payment promptness for services provided
  • Increase personnel efficiency
  • Achieve greater user and client satisfaction
  • Diminish / Eliminate losses
  • Reduce paper usage and inventory

Claim Status

EXCLUSIVELY WITH ProClaim®, VERIFYING YOUR CLAIM’S STATUS IS NOW EASIER THAN EVER.  Our constant pursuit of innovation has led us to integrate ProClaim® with the capacity of requesting the status of any claim in real time, with NO need to call the health insurance company.

With just a click the user obtain the status of a claim in less than 2 seconds.*

Some Advantages

  • Real time status
  • Receive status in less than 2 seconds
  • Status automatically registers in claim history

Find out if your claim

  • Is in the process of allocation
  • Was allocated and is in the process of payment
  • Was paid, and also see date and CHK/EFT number
  • Was denied
  • Hasn’t been received

*Claim Status feature is available for participating health insurance companies.

>>Read more

Integrating with your EHR/EMR

ProClaim®conveniently integrates with the vast majority of Electronic Health Record (EHR/EMR) systems available in the market.

This integration is achieved through the communication protocol Health Level-7 (HL7) and other proprietor protocols.  HL7 is a health industry standard that allows a seamless integration of different systems which in turn enables the sharing of relevant information throughout the medical facility. 

This EHR/EMR integration with ProClaim® prevents data entry duplicity, eliminates the majority of common errors committed throughout the process, and also speeds up and maximizes billing and collection of services rendered to the patient.  Read More…

Reports

One of ProClaim’s great advantages is precisely its versatility when generating detailed analysis and interactive reports.  We designed a matrix of all data processed in the system, which helps the user generate reports according to his/her needs.  To avoid printing, these reports can be exported to Excel and PDF.  The most utilized reports in ProClaim® include accounts receivable, collection effectiveness, production analysis, health plans, providers, locations, services, and diagnostics.


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NUEVO

“Unified Production Report”

Ver más…


Main Features

  • Patient Appointments – with group eligibility verification
  • Appointment confirmation through text message (SMS)
  • Automatic eligibility verification
  • Patient demographic record
  • Health insurance card digitalization
  • Patient photo
  • Patient I.D digitalization
  • Document digitalization
  • Integration with your Electronic Health Record (EHR/EMR)
  • Electronic billing
  • Delivery and reception of all electronic transactions
  • Automatic audit of acknowledgments of receipt
  • Automatic reconciliation
  • Creation of adjustment request forms
  • Monitor and follow up of Adjustments submitted
  • Tools to measure productivity and collections
  • Statistic reports of medical facility
  • UDS table formulations for Centers-330
  • Management of patient accounts receivable
  • Patient collection letters

A-Pay from ASSERTUS | Payment Integration with ProClaim®

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  • Via Internet
  • No need for additional lines
  • Finger mistake reduction
  • Signed receipts become digitalized
  • Control over users
  • Multi-user
  • Multi provider

Download our ProClaim® Brochure

ProClaim® Brochure Booklet

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To browse our brochure in virtual form, click on the image above.

ProClaim® Brochure Booklet - PDF

ProClaim-Booklet2016Filp

To browse and download our brochure in PDF form, click on the image above.

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