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EDI Compatible Medical Billing (E-COMB) is a web based solution for generating medical claims complying with the HIPAA transaction and code set standards, regulated by the US Government following the recommendations of American National Standards Institute (ANSI). The application is designed to generate, submit and reconcile the claims to the insurance carriers, guarantors and/or patients. This is one of the most important tools for doctors in realizing their revenue by reducing the turn around time in the claims reimbursement.

All the information related to environment of the Doctor’s Office/Hospital is grouped together as Master Data. This information is frequently used for claims processing and is less likely to change quite often. Master Data contains details of the Procedures, Diagnoses, Doctors, Payers, and Billing Providers etc. This data is created as part of the initial set up and can be updated easily at any time. E-COMB provides the cross-links at all appropriate levels in the application for the Master Data to be connected to the patient and subsequently to the claim automatically.

 
 

To facilitate the ease of dealing with vast amount of information, E-COMB provides versatile access to patient records. Patient information, including their demographics, Subscriber, Guarantor/Responsible Party information can be entered into the system at the time of enrollment. This information can be modified at any time. All the patient data is grouped together at multiple levels. Data for all the services performed on a Patient can be entered using the service level screens. The functional flow of the application is aligned with a typical process followed in a life cycle of a service.

For all enrolled patients, claims can be generated to submit to the appropriate Payer for the services provided. Claims are submitted to the Payer in the form of transactions. Each transaction can be bundled to have multiple claims either related to the same patient or to different patients. E-COMB automatically interprets the payment/advice received from the Payers. The data received from a Payer through 835 transactions is imported into the database and displayed as viewable screens.  E-COMB will provide several reports related to Patients, Services and Claims. Sorting order and filtering criteria can be defined on these reports to attain any level of detail. Reports can be printed on paper or exported to other applications or to a flat file. Pie charts and bargraphs can be generated.

 
 
Summary of Features :
  Electronic and manual claim generation, submission and reconciliation
  Compliance with HIPAA transaction and code set standards
  Send and receive EDI transactions
    HIPAA EDI transaction sets implemented and tested:
   
    837 – Health Care Claim - ASC X12N 837(004010X098A1)
    835 – Health Care Claim Payment/Advice – ASC X12N 835(004010X091A1)
  Code sets implemented:
 
    CPT-4
    ICD -9/ CM
    HCPCS
    NDC
  Master screens that are interwoven to have quick entry of data
  Recent Patient list eases the process of selecting patients
  Enter Services as and when data is available
  Pool the unbilled claims automatically
    Automatic Claim generation
    Bundle different claims into one transaction and submit it to the payer
  Reconciliation of 837 and 835 transactions for proper COB
  Audit Trials
  Sophisticated Reports covering all operations that are handled under E-COMB
  Context based Help on each individual screen
    Industry-standard, Multi-level security procedures
    Work from anywhere
   
 

Security
Through systematic use of Industry-standard security procedures, the application makes sure that only authorized persons have access to the system. All authorized users are given a User ID and a password with different access levels. For ease of operation, context based help facility is provided in the application.

Customization of E-COMB
E-COMB is a web-based product that can be further customized to meet your healthcare needs, irrespective of the size of the organization or the type of data being accessed. Scalability and modularity enables E-COMB to grow with the organization and facilitate making necessary changes quickly. KBTS will work closely with the key personnel at your organization to customize this product to your requirements.

E-COMB is approved by Blue Cross Blue Shield of Michigan (BCBSM).

To discover how KBTS can help your organization reach your IT goals, contact us by sending an email to

 
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