Revenue Cycle Management

Revenue Cycle Management

E3 Revenue Cycle solutions and technologies, built within and around sophisticated in-house Rules Engine and Application Configuration Tools, helps disciple/define/build complex rules and conditions and near-impossible business process flows with utmost ease and simplicity.

Patient Billing

In an increasingly competitive marketplace where healthcare costs are burgeoning and healthcare providers and payors alike are expected to control costs while maintaining business growth without the compromising exemplary patient care and positive health outcomes, the ability to manage data into information for rapid decision making in patient care is becoming imperative

E3 Patient Billing System is a leading part of the Business Office Solutions of E3 Healthcare Applications Suite. The module flexibly and comprehensiveness provides a platform for charging, tracking and consolidating billing information across the healthcare facility that enables full command of a business process environment, maintaining cost controls and revenue management. Charges can be entered directly, within other modules of Lawson and/or via interface with external systems.

The module’s core is its rules-building engine which validates the eligibility status of every patient for any and all services that may be requested. The flexibility of the user-definable rules-engine, which requires practically no manual intervention in the determination of eligibilities, differentiates E3 Patient Billing Module from the alternatives.

The Billing Module is seamlessly integrated to all in-house applications and receives data from:

  • Master Patient Index;
  • Registration; Pharmacy;
  • CPOE; Laboratory; and
  • Radiology amongst others.

It also acts as the feeder data source for

  • Approvals Management;
  • Claims Management (including e-claims),;
  • Accounts Receivable; and
  • Provider Payables, among many others.

Key Features

  • Built to accept information and integrate with any feeder system that complies with accepted norms of standard information exchange;
  • Robust rules-building engine that is required by electronically business scenarios of any nature;
  • fuses into the overall system and helps maintain effective cost controls and revenue management;
  • User friendly, multi lingual interface;
  • Exceptional user-definable reporting and MIS environment are defaults.
  • Flexible Rate Definitions; multiple rates definable
  • Industry Standards Compliance: HL7, ICD, CPT amongst others
  • Workflow Based System; easy configuration of work processes, policies, procedures…
  • Package Definitions; easy of defining any and all Inpatient, outpatient, daycare and any other type of packages
  • Configurable Financial Concepts; Flexibly Supports one or more or combinations of
    • Financial Concepts eg:
      • Pay As You Go
      • After the event
    • Centralized / Decentralized Cashier.
    • Approval Hierarchy for Refunds and Cancellations.
    • Outpatient Deposits and service availed against deposits.
    • Family Tree advance receipts / offsets handling (VIP)
    • Paperless Environment; dealing with payors, administrators, referrals etc

Insurance Contracts

Healthcare providers today render services within a complex payor environment. Government, employers, insurance companies, charities typically form part of a major and varied source of healthcare payor groups. Each group, in offering serving as a payor for care seekers, has its own set of policies, procedures, guidelines and limitations that govern payments for patient care.

These payors enter into contracts with healthcare providers or patients. The rules, policies and conditions contained in these contracts are the basis on which the payer will make payment. These contracts terms and conditions can be as diverse as the care seekers they cover. Healthcare providers seeking to manage the eligibility of their patient whilst ensuring optimal care, all within a manual environment will undoubtedly be faced with a monumental task of managing their billing, claims and receivables processes.

E3 Payor Management System provides the ideal solution, automating any or all contracts accepted by the practitioner / hospital and enabling real time and automatic processing of eligibility checks during the ordering process itself.

With this automatic process in place the practitioner or hospital is able to assure themselves that any or all services provided their patients are fully covered. This limits the need to manage denials, collections and delays in receipts due to an improper contract management environment.

Scrubs and Claims Processing

The claims processing procedure within the system is, by all counts, an exceptionally simplified process. Prior to finalization, claim audit processes are performed to ensure completeness and comprehensiveness. Editing claims is permitted with Specialized Rehab Hospital user authorization and should be completed in the originating system.

There is no need to have a clear definition of claims “period”. Accruals basis of revenue recognition is defaulted.

Claims can be in traditional manual form or thru paperless electronic environment. Claim submission can be multi-tied to include third party administrators and/or 

Integration to eClaims

Integration to eClaims module facilitates the submission and receiving of electronic claims transactions by employing CSV or XML formats.

It maintains up to date version of the claim formats by payer, thereby enabling the generation of the correct e-claim transactions. Any changes and updates are managed by E3 and the new versions delivered to the customer.

Currently the following country specific national health insurance standards are supported:

UAE: Shafafiya Transaction set (Abu Dhabi Health Authority)

UAE: eClaimLink Transaction set (Dubai Health Authority)

Qatar: MDS Transaction set (Supreme Council of Health)

This covers the submission of Claims and related transactions and the receipt (responses) from the third-party insurance organization or TPA

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RULES ENGINE

The Rules Engine forms the core of the entire Business Suite. The engine provides ultimate flexibility to define any and all rules conditions, processes, alerts and workflows that enable an almost a flawless and human-effortless environment.

Salient features include:

  • Ability to translate contracts line by line.
  • Diagnosis based exclusion.
  • Handles Exclusions, Deductibles, Coverage etc.
  • Specific Requirements like Deductibles on Gross, Deductibles on Net.
  • Patient Level Policy definition to handle Eligibility and Charity Patients.
  • Multiple payor to single patient
  • Ability to define Rules Based on any information and combination
    1. Service group , Category , Item Code
    2. Medicine Generic, Medicine Form, Medicine Category, Medicine Code
    3. Patient Sex, Patient Age, Patient Nationality etc.
    4. Diagnosis Code
    5. Doctor Specialty , Doctor Sub Specialty , Doctor Type