The SSI Group, Inc. provides hospitals and providers with solutions that address every phase of the revenue recycle from the point of registration through claims processing and after discharge. Embedded workflow solutions in ClickON® Technology provide process controls that automate and enhance every step of the revenue process. With SSI, hospitals gain superior customer service, connections to more than 800 payers and a host of tools that maximize AR.

Managing the HIPAA claims transactions process SSI works with hospitals hand-in-hand to provide an entire revenue cycle solution. Key transactions addressed through ClickON technology include:

997 - Transaction Acknowledgement
837 I / P / D - Institutional/Professional/Dental Claims
835 - Remittance Advice
270 / 271 - Eligibility Inquiry and Response
276 / 277 - Claims Status Inquiry and Response
278 - Precertifications/Authorizations/Referrals
275 - Claims Attachments

Beginning early in the patient encounter, ClickON E-Verify helps the admission/registration process by enabling a hospital to conduct the front-end functions of:

• Precertification/referrals
• Verifying insurance benefits
• Verifying patient demographics

And with ClickON Net Compliance, users can quickly determine if a procedure is deemed medically necessary. This is based on published rules from Medicare/Medicaid Fiscal Intermediaries published

Scalable Claims Processing Solutions
Because no two hospitals are identical with their business processes, ClickON Technology for claims management and billing is scaleable meeting the needs of any sized hospital or large healthcare facility. Available in either an onsite solution with either clearinghouse connectivity or direct-to-payer submission or an application service provider solution (APS) SSI’s claims processing software fits the unique needs of any large healthcare enterprise.

Along with SSI core technology for claims editing and transmission, there are a range of vertical products that facilitate and enhance claims management. These include:
Secondary and tertiary claims represent a large percentage of revenue for many hospitals. Billing these claims can be an efficient process with an integrated claims solution.

ClickON Secondary Billing enables hospitals to produce secondary and tertiary claims, along with a one-page Explanation of Benefits (EOB) attachment by posting 835 files (electronic remittances) to claims already in the billing package. Along with 835 files, the Secondary Billing package can post lock box files, payment files produced from the hospital information system and the Medicare pending payment files that the Accelerated Secondary Billing and ClickON Claims Status packages produce.

Capturing revenue from secondary or tertiary claims is vital to the financial success of a large healthcare enterprise and being able to capture it quickly is extremely important. ClickON Accelerated Secondary Billing assists with just that. This package is an enhanced version of the ClickON Secondary Billing package. Enhanced functionality enables the posting of pending Medicare payments to the appropriate claims in ClickON Billing after the checking the Medicare Common Working File (CWF) for their status. The entire accelerated secondary billing process allows claims to be billed to secondary payers before the primary payment has been received.

Tying the steps of the billing cycle together into a seamless, integrated process provides for major advantages. For instance, the billing secondary claims before the primary is billed can result in an eight-to-ten day collection advantage. The ClickON Claims Status Module (CCSM) is one solution that brings together multiple activities for working claims and providing detailed reporting. This advanced claims management system works directly with the ClickON Billing package to status Medicare claims using the Medicare Common Working File (CWF) as well as claims submitted to any other payers that provide the 276 and 277 claims status transactions.

With 14 percent of all claims denied, the healthcare industry is losing valuable revenue that negatively impacts the bottom line. ClickON Revenue Recovery Manager is an innovative denial management tool improves the overall revenue cycle by analyzing denied claims, providing workflow solutions and offering comprehensive reporting. This application can even prevent denied claims. Transaction data is analyzed and, based on predefined criteria specific to a particular facility, tasks to handle denied claims are automatically assigned to individual users or to everyone in a designated group.

Enhanced Functionality Offered by ClickON
Because no revenue cycle solution ends with simple claims management and transmission, ClickON technology provides additional solutions to help with managing contracts, auditing claims and posting.

Viewing the details of changes made to claims during the billing cycle is a necessity in these days of HIPAA and automated workflow. The ClickON Claims Audit Module is an add-on module that documents all system and user changes made on claims in ClickON Billing down to the transaction level, even viewing a claim. Anyone who views or makes a change to a claim can be tracked.

Manually reviewing claims against contract provisions is time consuming and therefore not always cost effective to search for and identify smaller variances. Identifying small errors in reimbursement can lead to big money. For example with a manual process healthcare facilities might pass up the opportunity to collect on a $200 underpayment in favor of a $ 10,000 underpayment. By being able to quickly determine underpayments on payer contracts through an automated method protects the integrity of agreed-to charges by payers – and the bottom line of hospitals. Without a contract management system, it is virtually impossible to track what a healthcare facility should actually be getting paid from a payer. According to the Healthcare Advisory Board, a typical 350-bed facility can lose $ 3.3 million in contract underpayments and denials every year. SSI’s ClickON Contract Management system can quickly determine underpayments on payer contracts by automating this process. SSI also offers contract modeling, which allows for side-by-side comparisons of current and proposed payment schedules.

Posting solutions can aid hospitals in claims tracking by posting notes directly to the collection comment area of the patient accounting system, thereby facilitating reporting as well as revenue recovery.

Remit/cash posting can be an automated process of posting 835 files to the accounts receivables system. With ClickON Remit/Cash Posting, remits are retrieved electronically from participating payers and posted to the individual patients’ accounts in the AR system automatically.
Ensuring the HIS is updated with information provided by the carrier for claims marked as rejected can be accomplished through the ClickON Reject Note Posting module.

Automating the posting of electronic payer confirmation reports to the notes/comments section of a facility’s information system is accomplished through the ClickON Confirmation Note Posting.

By posting the actual bill date for each claim billed into a facility’s mainframe and/or collection system automatically improves data management capabilities. ClickON Bill Date Posting enables users to post the actual bill date for each claim billed in the ClickON Billing application into a facility’s mainframe.

Claims with attachments are a challenge facing the healthcare industry with request for documentation to accompany the claim. Doctor’s notes, accident reports or other related information might be integral in getting a claim paid. ClickON Attachment Processing System addresses the paper claims attachment challenge, enabling hospitals and large healthcare facilities to consolidate paper claims with accompanying attachments for processing and mailing.

ClickON OnePoint Packages
Comprised of many of SSI's most popular products, ClickON OnePoint is an all-inclusive claims processing solution addressing claims editing, secondary billing, electronic remittance advices, claims statusing, claims auditing, even document management. The results are improved support, seamless integration and improved efficiencies.

ClickON DMS (Document Management System) includes:

Document management and workflow can be streamlined, digitized and, in general, made more efficient to help large healthcare facilities with managing the massive amounts of paper and processes abundant in providing care. ClickON Document Management System is a scalable solution enabling hospitals capture, archive, store, access and report on vital data and paperwork. All this is accomplished with an intuitive workflow solution that provides further efficiency. ClickON Document Management System includes:

Imaging and SAN Utilization: This is the basis for all other document management functionalities. Retaining documents digitally and indefinitely, Imaging offers secure, remote access to information through applied archiving and retrieval technologies.

Enterprise Report Management: This application provides for the input and storage of computer print files. Enterprise Report Management eliminates substantial and recurring printing costs and is applicable to any department in a hospital including the business, human resources, general accounting and medical records.

Optical Character Recognition (OCR): Reading scanned images and extracting editable text information, OCR allows documents to be automatically indexed, data to be automatically posted and workflow management processes to be started.

Workflow Management: As an innovative tool for creating efficiency and reducing costs for information handling, this process-oriented solution is specific to a hospital’s unique needs. Once information has been captured digitally, Workflow Management provides a hospital with document management, routing, workflow and tracking capabilities that follow a specific document or documents through all steps needed to complete information processing.

Along with the technology, SSI’s ClickON Business Services provides resources and solutions for:

Hospital Billing Services, which accelerates reimbursement through outsourced billing on an interim or ongoing basis.

Extended Business Office Services, which accelerates the reimbursement of all outstanding revenue through outsourced insurance and self-pay recovery services.

Paper Claims Editing, Printing and Mailing, enabling the easy and efficient outsourcing of these labor-intensive business office functions.

Contract Management Services, assists hospital business offices in reclaiming underpayments and negotiating for more profitable contracts on an outsourced basis.