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Revenue Cycle Management

E-Claim System for Hospitals and Clinics

Simplex E-claimer comes as completely integrated with our Simplex HIMES software suite. Helps Healthcare service providers to keep complete control over their receivables. It makes it much easier to followup with Insurance companies and corporates. It greatly reduces the rejection rate.

The management of revenue cycle processes – including billing and reimbursements – can be time-consuming and complex for a healthcare organization. Challenges include understanding and managing all reimbursement rules, regulations, and payor-specific variables. Tracking down the required supporting clinical details from within the organization may prove difficult as well. 

The Revenue Cycle module handles the most challenging billing requirements. Simplex HIMES simplifies service providers RCM team to manage most demanding Insurance companies, TPA’s and Corporates. Rules-based engine allow you to define payer-specific variables such as billing rules, clinical rules, code edits and reimbursement terms. Your staff enters contract variables once, based on the variables patient billing happens automatically making the most complex function easier to manage.

Modules and Features

Insurance

  • End to end Prior authorization workflow
  • Eligibility checks
  • Claim Imports
  • Claim Data management
  • Claim Submission
  • Claim Remittance
  • Claim Re-submission
  • Claim Reconciliation

Reports

  • Claim Submission report
  • Claim rejection report
  • Claim Re-submission report
  • Claim Analysis based on doctor, department, Insurance company, network and plan.

Masters

  • Insurance Company Master
  • Price List Master
  • Network and Plans
  • Copay and deductible rules
  • Coverage, exclusions 
  • Posting to Accounts