By leveraging the knowledge of our experienced billing & audit team with our highly-skilled programming team, we’ve been able to develop our own specialized proprietary software that enables our staff to complete their work in the most efficient manner possible. Our web-based software provides us with an advantage over most others because it has proven to be far easier to navigate and use than any other application we’ve come across.

In our particular line of work we must remotely connect to a variety of different host systems, billing programs and other application tools in order to accumulate the information and documentation necessary to perform our tasks. During this process we must constantly adapt to the various obstacles we come across while using these other programs.

Our software is also extremely scalable, and can often be made to function in accordance with another application. In fact, some of the programs we’ve created will connect to a hospital’s host system to retrieve the necessary data and bring it back to our side so that it can be formatted into documents that are far easier to read and understand than what is available.

We are constantly developing new tools and improving existing ones. Below are just a few of the data processing services and tools we have made available.

Electronic Remittance Advice Data Services (eRADS)
Whether it’s providing backup documentation for an audit or processing CIFs, Appeals or secondary billing such as Crossovers, the need for hardcopy Remittance Advice pages comes up quite frequently. The only problem is that it can be tedious and time-consuming to locate the exact RA page you need, especially if your RAs are stored in binders. As many employees can attest, it is very frustrating to discover that the binder you need has either been misplaced or the pages inside are either out of order or have become so damaged from being repeatedly removed, unstapled and/or photocopied that the are now illegible and practically worthless.

Our BillPro Data Processing Service was developed internally to provide our own staff with easy-access Medi-Cal and Medicare RAs. Here is how it works:

  • Retrieve: We automatically retrieve your electronic Remittance Advice files (whether ARDS or ANSI 835 format) and upload the data into our system. Medi-Cal ARDS files are picked up and processed as soon as they become available (typically every Monday morning), so there is never any waiting to access your information.
  • Lookup: Users can access their electronic Remittance Advice information by logging into our web-based system via Internet Explorer and perform lookups according to a variety of different fields (Account Number, HIC/ID#, Amount, Service Date, RA Date, RAD code, CCN or a combination of multiple fields).
  • Print: Perform as many lookups and tag as many records as you want. After you are finished, just click the ‘View’ button at the bottom of the screen and wait a few seconds while our program produces a PDF file containing the RAs you selected – and in the same order in which you selected them.*
*Our system arranges the data in the same format as the hardcopy RA that is mailed to the hospital by the FI. Also, the Medicare RAs our system generates is in the “National Standard” format, which is the required format when submitting Crossover claims to Medi-Cal.
Other ‘RA viewing’ products exist on the market such as PC Print and MREP. However, we’ve found none that are as easy to use as the applications & process we’ve developed for this purpose.

Custom File Creation
As part of our BillPro Data Processing service, we can also create custom data files from these electronic RA files, and in any format (Excel, PDF, TXT, TIFF, CSV, etc.). These files can be used to post payments, denials or suspense information to the hospital’s host system. The data can also be loaded into a spreadsheet which can be used for statistical purposes. Whatever your need, our software development team can create a custom on-the-fly program which will convert any data file (or series of files) into any custom report, document or file you wish.

Medi-Cal Eligibility Retrieval
We have created our own interface that allows the user to check the eligibility status of any patient without having to connect to the EDS website. By using our online software instead of EDS’s, many extra steps in the eligibility-retrieval process are eliminated. Here are the two related features we have available:
  • Interactive Manual Retrieval: Whether it is one or a few eligibilities you need to check, this feature is great because it provides the user with instant feedback for each record while keying in the next one. In other words, no navigating back-&-forth between eligibility checks. By keying data into only a few fields, our system will automatically go out to the EDS website, retrieve the necessary eligibility information and return it to the Listing screen below your work area – all of this automated activity occurring behind the scenes. By clicking the ‘View’ button, an Adobe PDF file is generated, containing eligibility printouts on all of the records you just keyed in (and…in the order in which they were keyed).

  • Batch Retrieval: This feature is very handy if you have an Excel or Text file containing hundreds or even thousands of records which require a Medi-Cal eligibility status. Essentially this is similar to how the ANSI 270/271 files work, but much easier. Just make sure the format of the Excel or Text file contains three basic columns of information (Medi-Cal ID#, Birth Date and Service Date). Click the ‘Upload’ button import the data into our system, wait a few minutes for the results to come back and then click the ‘View’ button to generate an Adobe PDF containing eligibility printouts for all the records you just sent up (and…in the same order as they appeared in the file). We initially developed a program that could generate an ANSI 270 file and also process an ANSI 271 file. But once again, too many steps and unnecessary complications. So we developed our own interactive process that automatically connects and retrieves data from the EDS website.