Healthcare payers operate in an unpredictable environment defined by high claim volumes and ever-changing payer rules and regulations. To further exacerbate these issues, legacy vendors may have stopped providing technology updates and failed to keep up with industry policy changes. With increasing demands for compliance and the pressure to keep administrative costs low, it’s essential to have flexible, automated solutions to help keep up with market demands.

Enter Compass Code Edits, Beacon’s clinical code editing solution that streamlines your claims adjudication process, improves payment accuracy, and reduces unnecessary medical costs with clinically-supported claims editing. And all of this is completed without any disruptions to your current workflows and before any payments are made. The system adds handling codes into the 837s you receive, in order to help tell your claims system and examiners what to do with them. Beacon has designed Compass to slide directly in front of your current processes, adding seamless code editing without changing your claims processing system.

Using 17 different automated billing guidelines published by CMS and developed in conjunction with the American Medical Association, Compass Code Edits systematizes the technology applied to code validation use on claims that has too often been left for manual review by medical professionals. The system flags claims that attempt to bill incompatible or unnecessary procedures by performing checks for medically unlikely or unnecessary combinations of events or codes, along with a host of other checks for reasonableness. All of these sourced guidelines mean nothing to your claims payment efficiency without the ability to configure our solution to fit your business model. For each group and trading partner, Compass allows users to activate or inactivate any edit, at any time.

Compass takes in all the eligibility that is offered in incoming 837s. However, there are additional advanced eligibility edits that Compass offers that may require additional development and/or integration with your legacy system. Likewise, some edits may require claim history for effectiveness, but SpyGlass can help flag these, again, by adding special handling codes to your 837. Your legacy system may require additional support for the provider matching capabilities that Compass can help with in conjunction with SpyGlass.

With health claims management being one of the most critical aspects of medical cost savings for healthcare payers, it’s becoming more and more critical to find a flexible claim editing solution that reduces the administrative and operation costs of accurate claim editing. Our fast, accurate results provide measurable value in increased claim auto-adjudication rates and savings on affected claims. Enhance your health claims management process with Compass Code Edits by adding increased accuracy and appropriateness checks for claims before any payments are made and without disrupting your current adjudication workflow.