“PrismPay360”

FUSE : Value Proposition

• FUSE provides remittance to payment auto reconciliation.

• FUSE eliminates the manual data-entry of posting into providers practice management or billing systems without disrupting the current billing platform or technologies.

• FUSE saves providers money by reconciling payments and reducing AR days allowing them to get paid sooner and have more money in their bank accounts much earlier.

A global cancer research facility was struggling with how to reduce manual posting, reassociation, and payment processing costs.  By implementing FUSE and Big Data services, the facility reported cost savings of nearly $100,000 per month.  Rather than reducing the complete headcount, the Central Billing Office redeployed FTEs to revenue-generating tasks such as  working denials and exceptions, underpayments, and collections.  AR Days improved from 58 to 34 days and revenue improved an average of $74,000 per month the first 6 months due to the corrective actions found and improved by the reallocated staff.

Over $600,000 in Annual Savings


43% Improvements in AR Days

Payment and Remittance Challenges

In today’s environment bottle necks are costly. Here are some examples of administrative costs to provider:

✓ Remittance (ERA or EOB) and correlating payment (EFT or Check) can arrive at different times, essentially creating a costly “matching” administrative function

✓ Reconciling the remittance to the payment is an important business office process prior to remittance and payment posting to ensure deposit accuracy and reducing the chance of FRAUD

✓ Manual paper EOB and correspondence handling within the business office requires manual posting and reconciliation 

✓ Patient payment handling is difficult to reconcile when paid by credit card and costly by paper check 

✓ Correspondence documents are increasingly in demand but the manual process creates errors and mishandling of urgent documents requiring immediate attention

Three Main Focus Areas

FUSE

Automated 835 to Deposit
(EFT / Check)

Matching &
Reconciliation

AutoPort

Payer Portal website automation

Automated Data retrieval
(EOB and/or PDF remittance retrieval)

EOBX

Existing Lockbox Conversion

Paper Conversion to Electronic
(EOBs, Correspondence and Patient Pays)

FUSE: Automated 835 to EFT Reconciliation

FUSE provides a full range of receivables management and research tools.

• These tools work in tandem with a healthcare provider’s practice management system(s), existing
bank, and existing clearinghouse.

• Our SAAS model is non-disruptive and is designed to increase and improve revenue, put money in your bank accounts sooner, reduce FRAUD, shorten the revenue cycle, reduce your AR days and decrease manual processing costs.
"“Fuse”

Claim Payment Management

• Improves cash flow via expedited payment and remittance reconciliation through the receipt of electronic payments and remittances

• Eliminates the need for manual re-keying of reconciliations of EFTs and ERAs by requiring a trace number that links the two transactions so payments can be associated with service

• Increases ability to conduct targeted payment issue follow-ups through uniform and maintained ERA codes (CARCs, RARCs, and CAGCs) to give the market consistent approach to reporting and interpreting the claim denials/adjustments

• Standardizes enrollment for EFT/ERA so providers can sign up for both EFT and ERA electronically with all health plans using a consistent set of data elements

• Automates re-association of EFT and ERA leading to efficiencies and reduced errors for payment posting, avoiding FRAUD and leading to fewer A/R days

• Saves providers money by reconciling their payments and reducing their AR days allowing them to get paid earlier and have more money in their bank accounts much sooner.

Healthcare Claims and Revenue Recovery Opportunity

Recover additional revenue from un-paid under-paid claims

Critical time for Hospitals to refocus on revenue cycle for commercial business. 58% of claims initially denied

Hospitals received payments from Medicare and Medicaid less than costs. Combined underpayments were $68.8 billion in 2016.

A typical cycle will find between 3% – 9% in billing errors.
Our technology can yield millions per month in additional revenue for HCA

Market Readiness

Monitoring Services:
Available Immediately

Lead time
4-6 weeks for goods

Patient Engagement Center:
Available Immediately

Implementation time
approx. 2 weeks

 VitalPay 360:
Available Immediately

Implementation time
approx. 2 weeks