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YEI ClaimScrub™

Claim scrubbing and claims processing systems for clearinghouses, payers, TPAs, and providers. We offer complete off-the-shelf systems, as well as components which may be integrated with existing systems.

YEI ClaimScrub™: Comprehensive Claims Processing Suites

So happy we're going to bake you a cake and mail it to you! SSI, Illinois

...it is a pleasure to work with Yost. IB, Brentwood, TN

Yost Engineering is a leading provider of data services and back-end processing services for healthcare clients of every size, supporting up to 150M claims per month. We provide expertise and assistance for all of the claims processing data and systems that we provide and, in addition to our standard off-the-shelf claim scrubbers, can also efficiently customize a solution to meet any need.

Claims can be accepted in XML and standard ANSI X12 formats, as well as raw data from billing and processing systems. Claims input formats can be configured to your system output specifications, and ClaimScrub response messages and processing results can also be customized if necessary to be compatible with your existing processing systems.

Download an overview of the ClaimScrub suite of products and services.

Benefits for Providers

Identify and correct coding and claim issues prior to submission to payers, reducing claim denials
Reduce claim turnaround time, reducing overall A/R days
Reduce costs for rejected and resubmitted claims
Edits updated daily from payers and standards organizations to ensure timely compliance
Create and maintain your own custom edits quickly and easily

Benefits for Clearinghouses

Comprehensive claims validation modules, updated daily
Batch-processing, real-time, or full integration with your systems
Cost-effective solution, avoids devoting staff-time to entering and loading medical necessity, coding, and validation changes
Build client-specific edits as necessary, improving customer retention and satisfaction
Online access to YEI Policy Locator Payer WEB, allows quick access to research payment and edit questions
Single YEI ClaimScrub server can process up to 1 million claims per day; servers can be chained to allow higher throughput, and load-balanced to maintain high responsiveness

Benefits for Payers and TPAs

Maintain industry-standard claims edits automatically, improving provider relations, and increasing accuracy of processed claims
Build custom claims edits as necessary
Reduce staff maintenance and review time
Integrate with legacy systems, or supplement existing processing capability
Ensure HIPAA-compliant transaction sets
Historical edit profiles allow correct processing of older claims
Edits updated on a daily basis from standards organizations to ensure timely compliance
Online access to YEI Policy Locator Payer WEB, allows quick access to research payment and edit questions
Single YEI ClaimScrub server can process up to 70K claims per minute (1100/second), and are rated for up to 1 million claims per day; servers can be chained to allow higher throughput, and load-balanced to maintain high responsiveness

YEI ClaimScrub Solutions

Which solution is right for you? ClaimScrub is available in two distinct packages to ensure we meet the needs of all of our clients, and that clients can migrate to larger solutions as they grow.

YEI ClaimScrub™ WEB: ClaimScrub WEB offers a web interface and web-based utilities, so all maintenance and upgrades are managed for you. The web interface allows both standard and custom scrub sets to be implemented, and custom coding rules can be set up for any claim profile(by provider, service type, payer class, etc). Claims may be loaded in batch mode, or via a real-time secure TCP/IP based query service. Includes unlimited toll-free and email support. Standard input in 837 or XML; custom input formats available at no additional charge.
YEI ClaimScrub Server Option: YEI ClaimScrub Servers are designed for deployment on the client's own network, and set up for high-volume loads. ClaimScrub Servers can be run individually or chained to increase total capacity and throughput. All maintenance and data feeds continue to be managed by YEI, freeing your staff to manage your core operations. Rack-mountable servers are provided on a month-to-month lease, with on-site server set-up and configuration. All contracts include server maintenance, support, and a comprehensive warranty. Load-balancing and fail-over available for multi-server deployments.

YEI ClaimScrub™: Components and Modules

YEI ClaimScrub can be set up as a comprehensive claim scrubber checking all claim data against a large library of maintained industry-standard or custom edits. It can also be configured to provide only the specific modules or data checking required, as a stand-alone system, or as a supplement to other claims processing systems that lack functionality in certain areas. YEI ClaimScrub can also serve as a bridge between non-compliant legacy processing systems, and HIPAA-standard transactions.

Core Modules Include:

Medical Necessity (Medicare MAC/FI/Carriers, Private Payers, Custom Edits)
Code and Modifier Validation (CPT, HCPCS, ICD-9, ICD-10, PQRI, NDC)
Correct Coding Usage Validation (CCI, NCCI, MUE, OCE, etc)
Place of Service Editing
Usage Warnings, Proper Coding Guidelines (age, gender, maternity, frequency, units, etc)
Reimbursement and Payment (revenue codes, DRG, MDC, APC, payment splits, etc)
Claim Processing Data (CARC, RARC, status codes, etc)
Fee Calculation Data

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