Overview

Verify eligibility PRIOR to submitting claims for adjudication by performing a 270 Eligibility transaction.  From the DSG claim, connect real time to review eligibility for a Single Claim, or automatically run Batch inquiries for all claims as they are loaded to DSG.   Correct discrepancies before submitting claims to the payer to improve cash flow.  

Features and Benefits

• DSG’s automated eligibility increases Cash Flow by reducing eligibility denials and increase productivity by eliminating telephone or internet verification.  
• Healthcare providers are now able to conduct eligibility transactions more efficiently with higher accuracy for pennies on the dollar.
• Finding eligibility issues at the time of billing saves considerable labor and increases cash flow vs. waiting for the denied payment only to start the billing process over
• DSG links the 271 Eligibility Responses directly to the DSG claim, simplifying the process of performing a new eligibility check or reviewing previous results.   No need to change applications!

Medicare Eligibility - DSG establishes a direct connection into the National Medicare database at CMS to receive benefit information enabling your facility to retrieve eligibility benefits for the patient even if they are from out of the area.  If there is a discrepancy in the eligibility information, DSG will error the claim for further review prior to billing.   

Medicaid – Check Medicaid eligibility in batch or for a single claim direct from the DSG claim screen.  

Insurance – Available for participating payers.  DSG will can perform batch eligibility for all participating commercial payers, or select which payers you want to check automatically. Flexibility is the key to this application.  

Medi-Cal – DSG has performed millions of Medi-Cal eligibility transactions over the years and can help you identify claims that should be billed to Managed Care payers vs. the State Fee for Service program.  Run the eligibility as claims are loaded and identify those that are not eligible or directed to the wrong payer.

Medi-Cal Self-Pay Eligibility – Perform eligibility verification for all self-pay accounts.  Many times patients forget they have Medi-Cal Eligibility or don’t have their information at the time of registration.  Patients that receive retro-eligibility can easily be identified so the claim can be billed to the appropriate payer.

Claims Status

Overview

Perform 276 Claims Status transactions after claims are sent to payers to determine the status.  As with DSG’s Eligibility process, 276 transactions can be run manually or in batch mode with the 277 response linked to the DSG claim.

Features and Benefits

• Automating 276 transactions provides a fast and efficient means of determining the status of a claim
• Options to check payment status in batch mode or for an individual claim provides the flexibility to select which claims you want to retrieve status for.
• Upload 277 responses to your patient accounting system to alleviate manual processes
• Link all information to the DSG claim for easy access and follow-up.
• Incorporating this process in the DSG system creates greater efficiency as staff do not have to work within multiple systems