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Electronic Secondary Bill Review (SBR)

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CHALLENGE:

States have passed mandates that require submitters to send Secondary Bill Review (SBR) or appeals using a pre-defined process that requires the inclusion of additional documents and applications for consideration.

MARKET EFFECT:

Large submitters are directly affected by this new requirement, as submitting SBR transactions is a large part of managing AR and cash flow. While most large companies have manual workflows to handle the submission of SBR transactions with necessary supporting documentation (i.e. EOR, original bill and attachments, inclusion of necessary mandated forms) the additional jurisdictional requirements stress those processes dramatically.

SOLUTION:

WorkCompEDI® developed an automated way to efficiently process SBR transactions which has helped our clients save millions on potentially lost compensation for services rendered.

HOW IT WORKS:

  • Submitters send EDI billing through WorkCompEDI®

    • Payers send back 835 remittance transactions to submitter through WorkCompEDI® —OR- they send back a paper EOB/EOR in the mail
  • Paper EOB/EOR transactions are sent to WorkCompEDl (mail or scanned image), and converted to electronic records (835) through advanced OCR/KFI processes.
  • The iCompEDI® system automatically creates an electronic SBR from the bill record in the WorkCompEDI® clearinghouse system, which includes:
    • New SBR record (including original bill data)
    • Submitter is allowed to add/modify SBR details online through iCompEDI®
    • An image rendition of the original bill and supporting documents sent are attached
    • A Proof of Service (POS) attestment letter (auto-generated by WorkCompEDI®) is attached
    • A rendition of the electronic 835 returned
      • If an electronic 835 is not returned, the submitter is prompted to attach an image of the paper EOB/EOR
    • Finally, the user is prompted to add additional supporting documents
  • WorkCompEDI® then transmits the SBR to the receiving party electronically (over 3,200+ EDI routes available today).
    • If the receiving party does not accept SBR electronically, WCEDI will print & mail the SBR packet (USPS 1st Class), and attach its IntelligentMail™ Tracing & Tracking identifier so the packet can be traced through the USPS system (like certified mail).

ADD ON VALUE OPTION:

Key metric and management reports (online and off-line) are available to track success of Automatic SBR system usage and tie back to cash flow and AR reductions. Processing SBR has become very difficult, but WorkCompEDl has found a way to give the submitter market the power to handle SBR transactions in a way that can maximize revenue and reduce AR without crippling limited resources.