Revenue Cycle Management

SmartCare™ Billing provides a combination of traditional fee for service billing with commercial payers and Medicare -- and varying requirements for prior authorizations, complex billing routines for Medicaid, Medicaid Waiver and Medicaid MCO’s. SmartCare also provides billing functionality for inpatient, residential and community-based IDD programs and primary care services.

Full HIPAA Compliant Billing Engine

  • Financial dashboards for incomplete financial records of clients and plans
  • Unbilled claims, unposted payments, real-time alerts and messages
  • Services that were flagged by a user or the system and need further investigation

Reception / Registration

  • List clients scheduled for the day
  • Receive payments
  • Reschedule appointments, Mark as"Show", "No show"
  • Send message and text to clinician about client's arrival
  • Captures multiple episodes
  • Tracks guardian, financially responsible and referral information

Service Documentation

  • Records services for a client delivered by a clinician and/or through a program
  • Validates service entry by clinician/program/procedure code
  • Validates the following (if required by the payer):
    • A signed note exists
    • Procedure code specified is on the treatment plan
    • Reimbursement rules are checked for the payer

Service Charges

  • A "completed" service becomes a charge
  • Handles payer priority and billable procedures
  • Service claims
  • Ability to create client statements
  • Ability to create paper and HIPAA 837 electronic claims, and configurable invoices
  • Re-bills, and collections processes

Service Payments

  • Post payments back to services via electronic remittance
  • Ability to flag, note denied or underpaid claims
  • G/L interface

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