| Function |
Feature |
Wellington
AuditNavigator™ |
| Tracking and Management |
User configurable (payers, audit type, events, issues, time frames, custom fields) |
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| User-specified workflow (tasks, responsible person, alerts) |
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| Appeal Type Sensitive Workflows (medical necessity, coding, etc.) |
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| Historical claim database for easy data entry (up to 3 years of claims history) |
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| Electronically scan request letter information into the system |
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| Retrieve data from claim history database to minimize data entry |
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| Task work list by user |
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| Peer-to-Peer Appeals Scheduling |
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| Automatically checks if claim was previously requested or excluded from audit |
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| Document repository (upload and attach document in pdf, doc, xls format to request or claim) |
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| esMD –Electronic Medical Record Submission to participating CMS contractors (MAC, RAC, etc.) |
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| Attach comments to request or claim |
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| Auto recoupment deadline alerts |
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| Cost tracking - Track pages copied, postage and any other costs by claim |
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| Appeal letter templates populated with data from claim |
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| Task status dashboard with drilldown to individual claims |
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| Generate CD/DVD containing requested medical records |
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| Supports most all audit/appeals processes (RAC, Medicaid, CMS, ZPIC, MIC, PrePay, etc.) |
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| Log all RAC financial offsets using 835 remittance files, attach to claim and notify user |
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| Generate AHA RACTrac compatible summary file |
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| Pre-Bill Audit tracking and support |
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| Case Management tracking and documentation support |
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| Tracking of Inpatient claims rebilled as outpatient claims |
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| EHR Integrated |
Electronic Document and Information Exchange – Platinum Level Approved for all EHR appeals |
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| Auto-populates EHR required documents |
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| Automatically updates document status from EHR system (appeal levels, denials, etc.) |
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| Reporting |
Activity Dashboards |
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| Financial In-Process Reporting |
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| RAC Take-back (via remittance (835) processing) |
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| Summary by DRG |
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| Data Integrity Analysis |
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| Denial Recovery Rate |
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| EHR Status Report |
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| Request Status Summary |
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| Claim Issue Listing |
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| Appeal Status |
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| Management summary |
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| Ad hoc Reporting |
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| Automated Interfaces |
Medical Record Retrieval |
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| RAC Site Monitoring and Data Collection |
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| FISS System Monitoring and Data Collection |
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| System |
Web-based (.Net/SQL Server/LDAP) |
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| Multiple payers |
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| Multiple hospitals/entities |
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| Secure FTP claim upload process (daily database updates) |
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| Secure remote access by authorized external users (e.g., coders, attorneys) |
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| HIPAA/HITECH Compliant |
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| Security Monitor Reporting |
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