From Payment Processing to Adjustments, Denials and Payment Validation, RCMS ReSolve™ Eliminates Manual Data Entry Tasks and Increases Overall Performance

Healthcare Payment Processing and Validation

ReSolve™ Payment Processing is at the core of our Revenue Cycle Management (RCM) solution, providing for efficient capture, management and use of patient and payment information to dramatically improve posting accuracy and exceed benchmarks. Our Payment Processing solutions integrate with existing patient billing systems, allowing for accurate capture and processing of patient payment information from both EDI and paper. Once complete, the system transfers payments directly to the billing system using client-defined posting rules while monitoring denials and other conditions.

While most payments today are processed using EDI, RCMS also provides the ability to capture all forms of paper-based EOB’s. Operators can also key data from a scanned image with underlying audit and batch control procedures. For higher volume paper EOB’s, we use optical character (OCR) technology and Robotics Process Automation (RPA) to eliminate manual data-entry tasks, increasing accuracy and overall performance.

RCMS ReSolve™ Payment Processing solutions automate workflow, improve efficiency and reduced costs. We will tailor our solutions to your specific business office environment and mix of electronic remittance and paper EOBs.


Payment Validation

ReSolve™ Payment Validation helps to scrub and cleanse the data before posting. We automatically check for errors, validating information needed for processing while improving data integrity. Once data is captured (EDI or paper), Payment Validation begins applying client-defined rules to find potential cash application errors before posting and routing those error back to work queues for correction. Payment validation verifies batch control totals, compares payment transactions (with patient import files) and routes exceptions to an operator for correction, and provides assisted navigation to the appropriate page

Contracts / Payor Rate Verification

Having accurate historical data is critical to optimizing payor contract negotiations. RCMS helps to ensure that your organization is receiving the best rate for services by automatically comparing reimbursements against payor contracts. With a payor rate matrix, you can systemically review all remittance data comparing against configured fee schedules.

RCMS ReSolve™ Payment Processing Benefits

  • Integrated process for all data sources
  • Rules-based validation performs look up for missing data
  • Comprehensive interface to post payments, adjustments, transfers, zero pays, comments and other transactions
  • Get to the point where you’re only handling exceptions
  • Payments and all related transactions are processed from a single interface
  • Image-enabled editor to resolve posting edits
  • Reliable capture of all denial codes
  • Timely secondary billing
  • Reduce staffing costs for payment posting and related transactions
  • Eliminate EOB filing and retrieval
  • Consistent processing rules reduces posting errors and reprocessing

RCMS Healthcare Provider Solutions:

Patient Access | Correspondence Management | Follow Up & Collections | Payment Processing | Bank Reconciliation | Denial Management | Reporting & Analytics


ECM for Payment Processing & Payor Rate Verification

RCMS provides for hosted or on-site Enterprise Content Management (ECM) that provides staff with quick access to indexed, searchable documents in all formats. Contact RCMS to learn more about our ECM Document Management Solutions that can help to improve Payment Processing and Payor Rate Verification for your Health System, Hospital or Practice Group.