About Our Software

Overview

Hospital organizations are encouraged to purchase PrimeSUITE and offer it to practices affiliated with their healthcare systems. In turn, with many practices today using PrimeSUITE, PrimeENTERPRISE can be used to facilitate controlled sharing of data and master files by those practices.

Designed with Flexibility in Mind

At the forefront of any large enterprise is a plan for growth. And with this growth comes the demand for a solution that allows for easy addition of new practice entities and quick changes in setup options. PrimeENTERPRISE has this flexibility – it can easily establish multiple configuration options for varying types of practices in the organization and add and remove practices from the enterprise.

Features
Centralized business functions Claims processing Statements processing Payment posting Collections follow-up Enterprise level roll-up reporting Service analysis Productivity analysis Reimbursement analysis Payer mix Denial analysis Clinical condition analysis	Data sharing Patient demographics and insurance Account balance Account flags Clinical summary Centralized master file maintenance Insurance Fee schedules Adjustment codes Procedure codes Providers Configuration files

Features

Centralized business functions

Claims processing
Statements processing
Payment posting
Collections follow-up

Enterprise level roll-up reporting

Service analysis
Productivity analysis
Reimbursement analysis
Payer mix
Denial analysis
Clinical condition analysis

Data sharing

Patient demographics and insurance
Account balance
Account flags
Clinical summary

Centralized master file maintenance

Insurance
Fee schedules
Adjustment codes
Procedure codes
Providers
Configuration files

BackOffice

Our BackOffice software offers advanced technologies that improve your finances and cash flow.

Payer Exchange Manager streamlines every stage of the transaction process, ensuring that your claims are processed as efficiently as possible. Always active, Payer Exchange Manager ensures that claims are processed even outside of normal business hours. It can react to primary and intermediate X12 payer responses without human intervention.

Processing claims directly with the payer, allows our technology to insert a unique electronic fingerprint on outbound claims, which allows BackOffice to record every event that transpires over the life of a claim. Billing staff can monitor claim progress from one simple user interface, from acceptance right through to explanation of benefits and electronic funds transfer—faster than ever before.

The BackOffice Exception manager only captures claims for which the system’s business logic needs assistance in in interpreting your data. Once the system learns why these exceptions are occurring, the business logic will be added to the system so that similar denials will cease to occur in the future, significantly minimizing the quantity of claim exceptions billing staff must resolve.

The Claim Scrubber includes:
• Demographic Scrubber, which ensures that the basic elements of claims are valid and correctly formatted
• Coding and Diagnosis Scrubber, which looks for ICD-9/CPT mismatches based upon Medicare and CCI rules. The rules not only identify sources of denials, but also identifies overlooked CPT Codes
• Payer-specific edits which can vary across insurance companies
• Re-ordering of claims based on client-specified rule sets, allowing the maximum reimbursement for your practice. Without halting the claim, Claim Scrubber will fix and re-order it automatically.
• Practice-specific rules, easily implemented and maintained by our Electronic Data Interchange (EDI) team. Common billing mistakes can be added to your scrub routines; these can then be displayed in the Exception Manager or, in many cases, automatically fixed and sent without user interaction.