YEI Healthcare Division
YEI's Healthcare Division offers both off-the-shelf and custom medical necessity, coding, and compliance products, as well as a wide variety of data files and claim scrubbing services. Our products can be accessed through software, web services, data subscriptions, back-end web interfaces and hosted solutions.
Solutions by Product Category
YEI provides software, services, and data to clients of all types, including providers, suppliers, clearinghouses, payers, software vendors and web service vendors. From multi-state hospital facilities to solo physicians, from laboratory systems to medical device manufacturers, from payers to claims processors, we provide comprehensive support and the most accurate data in the industry.
Each of the below products and data services can be deployed to meet your specific needs now, and can be updated as your needs change. YEI Healthcare is a leader in cost-effective products, unparalleled in-house customer service, and broad staff expertise to help with every step of your implementation.
- ABN Assistant WEB
- Verify medical necessity quickly and easily before services are provided. Correct coding problems or issue CMS-compliant ABN forms as needed, including cost estimates and specific reasons for non-coverage. Print reference materials for ordering physicians, generate comprehensive reports by procedure, patient, physician, and for audit and training purposes. Includes encoder and full suite of coding tools. Electronic signature capture option. Available in packages for enterprise-level deployment, laboratory, radiology, cardiac services, and physician office. Completely hosted web application, can be accessed by users at any time from any location.
- Medical Necessity Tables
- Comprehensive medical necessity files for NCDs, LCDs, and MACs, as well as commercial payers. Single-facility or redistribution licenses. Standard or custom formats, including CPSI, Epic Systems, Merge / Fletcher-Flora (LabPak, FFlex eSuite), Iatrics (MNO, LAB e-Laborate), MediTech & other systems. Compiled entirely from original sources by our in-house staff of professional coders and proprietary AI systems, updated daily. The most accurate data in the industry.
- Medical Necessity Claims Validation
- For medical necessity data files and dictionaries for use in other systems, see Medical Necessity Tables, above. However, to validate a broad range of medical necessity and correct coding rules through single claim submission or batch submission process, we also offer medical necessity modules through YEI ClaimScrub. Web-based solutions for small providers and vendors, and web and fully managed network-appliance solutions for large claim volumes.
Exclusion Checking and Provider Identification
- Immediately verify that providers, employees, and vendors are not in Medicare's Excluded Party database. Allows individual instant checks as well as automated periodic batch checks. Cost-effective, efficient, simple to use, unlimited flat-rate use. Includes OIG, GSA, SDN and state programs, including EPLS, LEIE, OMIG, and others.
- A free search tool that allows users to find NPI numbers as well as practice information for physicians, hospitals, and other healthcare providers.
ClaimScrubbing and Data Files
- YEI ClaimScrub
- Claims scrubbing systems for pre-submission review by providers and clearinghouses, and for payment-processing auditing by payers. All clinical editing system data is prepared in accordance with industry standards including correct coding initiative and national grouping, coding, and editing policies. Standard interface allows comprehensive custom rule sets and universal or limited application of either standard or custom rules. HIPAA-compliant transactions and code sets. Server, appliance, ASP, and web-based options. Flexible packages meet the needs of organizations of all sizes.
- Data Files
- Comprehensive coding, payment and reimbursement data in files ready to load into databases, spreadsheets, third-party software, and more. Procedure (CPT, HCPCS, modifiers, hierarchy, usage flags), diagnosis (ICD-9, ICD-10, hierarchy, usage flags), dental (ADA), medical necessity (LCDs, NCDs, MACs, CCI, NCCI, MUE, allowed/non-allowed diagnoses, allowed/non-allowed procedures, frequency restrictions, permissive edits, multiple required diagnoses, more), facility (APC, DRG, MDC, revenue codes), BETOS, NDC, place of service, crosswalks, fee schedules (ambulance, ambulatory surgery center, anesthesia, DME, physician, clinical lab, PEN, drug), claim format specifications (CMS-1500, UB-04, 270/271, 837), zip code verification, and more.
- EpiCoder WEB
- Complete outpatient medical encoder solution, providing access to medical coding tools, codes and references across all specialties. From correct coding to usage guidelines, to billing and reimbursement information, to a medical dictionary, EpiCoder provides comprehensive information in a web-based solution that can be accessed from anywhere.
- Standard or custom coding engines, reimbursement calculators, look-up tools, and components for use in third-party vendor products, ASP, and web services.