Claims Management

This guide covers the claims management features in Cognix Health, designed to streamline your insurance billing process.

Claims Creation

Basic Features

1. Claim Generation

• Automatic creation
• Template selection
• Service code mapping
• Modifier support
• Multi-line items

2. Data Validation

• Required fields
• Code verification
• Amount calculation
• Date validation
• Provider credentials

Claims Submission

Submission Process

1. Electronic Filing

• Direct submission
• Batch processing
• Clearinghouse integration
• Real-time validation
• Confirmation tracking

2. Paper Claims

• CMS-1500 generation
• Batch printing
• Mail tracking
• Document storage
• Reprint options

Claims Tracking

Status Monitoring

1. Claim Status

• Submission tracking
• Processing updates
• Payment status
• Denial tracking
• Appeal status

2. Timeline Management

• Filing deadlines
• Response tracking
• Appeal windows
• Payment expectations
• Follow-up schedule

Payment Processing

Payment Management

1. Payment Posting

• ERA processing
• Manual posting
• Bulk posting
• Payment allocation
• Adjustment handling

2. Reconciliation

• Payment matching
• Balance tracking
• Adjustment review
• Write-off management
• Patient responsibility

Denial Management

Resolution Process

1. Denial Tracking

• Reason codes
• Denial patterns
• Resolution steps
• Appeal tracking
• Success rates

2. Appeal Process

• Appeal generation
• Documentation gathering
• Submission tracking
• Response monitoring
• Resolution documentation

Reporting

Analytics

1. Claims Reports

• Submission volumes
• Success rates
• Denial analysis
• Payment trends
• Aging reports

2. Financial Analysis

• Revenue tracking
• Collection rates
• Adjustment analysis
• Payer performance
• Provider productivity

Best Practices

Claims Management

1. Submission Guidelines

• Clean claims
• Timely filing
• Complete documentation
• Code accuracy
• Authorization verification

2. Follow-up Process

• Regular monitoring
• Proactive outreach
• Documentation updates
• Appeal management
• Payment verification

Staff Training

1. System Usage

• Claims creation
• Submission process
• Status tracking
• Payment posting
• Denial management

2. Compliance Requirements

• Coding guidelines
• Documentation standards
• Filing requirements
• Privacy rules
• Security protocols

Remember to maintain accurate records and follow up on claims regularly to ensure optimal reimbursement.