Healthcare Claims Management Software

Gain Faster and More Accurate Claims Workflows

Filing claims and collecting payments from commercial and government payers is the financial lifeblood of your organization. Powered by insights drawn from ZirMed’s network of thousands of providers and organizations, our award-winning claims management software streamlines and automates your entire workflow for faster and more accurate medical claims processing, lower costs, and higher efficiency.

Connect with Payers Seamlessly

With one of the most extensive real-time medical claims processing solutions in the industry, ZirMed’s Claims Management solution offers electronic connections to virtually all payers. ZirMed supports both professional and institutional claims. For Medicare claims, ZirMed provides easy access to the Medicare FISS Direct Data Entry system.

Accelerate Healthcare Claims Management

With ZirMed’s Claims Management solution, your organization benefits from an industry-leading first-pass clean claims rate that exceeds 98%. ZirMed’s crowdsourced data from our payer edit and rules engine ensures a high likelihood that your claims are paid correctly the first time. ZirMed scrubs and executes all claims, including batch submissions, in real-time. The system doesn’t hold entire batches of claims if only one claim requires rework.

Simplify Complex Healthcare Claims Management Processes

Complex and confusing rejection messages slow down the entire claim management workflow. However, with ZirMed’s Simplified Response Message solution, users receive an easy-to-understand communication with a “How to Fix” link that provides a step-by-step process to resolve a rejection or error notice. In addition, ZirMed’s Claims Management solution handles both primary and secondary claims. It also simplifies the process by pre-populating fields on the secondary claim using information from the payer’s returned 835 EOB. The solution also facilitates electronic claim attachment submission for workers’ compensation and auto claims.

ZirMed’s proof of timely filing capability creates a report showing the original submission information. You can use this to accompany a denied claim if a payer says the deadline was missed.

Improve Staff Efficiency

ZirMed’s Claims Management software solution enables easy-to-create workgroups so staff members see only the claims you want them to work. Automatically assign rejections to a user or group of users based on a set of defined rules. You can also give each assignment a priority level. ZirMed increases your efficiency by automating the payer enrollment process and minimizing disruptions during implementation.

Integration Capabilities

By design, ZirMed’s revenue cycle management platform enables creators of healthcare technology solutions to seamlessly and easily incorporate our HIPAA and PCI-compliant applications and transactions into your software solutions. Using ZirMed’s integration capabilities, organizations seeking a traditional approach of exchanging EDI transactions may transmit and receive a variety of claims, payments, eligibility inquiries, and other healthcare transactions using established technologies and methods such as X12 files, APIs, Flat Files, FTP, Encryption (i.e. PGP), and more. You’ll have confidence knowing that your exchanges are occurring securely, in compliance with all regulatory guidelines, and utilizing existing technological capabilities.

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