Billing
In SETWorks you can bill for all services with just a few clicks. Whether it’s electronic or manual, our billing system and reports are intuitive, save time and reduce error.
Features
Automated Validation
Checks to ensure data is ready to be billed
SETWorks validates data as it is entered, as well as notifies billing staff of errors that may lead to billing being rejected. ICD10 codes are validated, addresses are confirmed against the USPS database, Medicaid statuses are reviewed, and many other rules are evaluated to help ensure your billing is completed and submitted accurately the first time.
Global Format
Supports global standards in electronic billing formats for healthcare data
SETWorks utilizes the HIPAA EDI 837 Health Care Claim Transaction Set and the HIPAA EDI 835 Health Care Claim Payment/Advise Transaction Set. Additional EDI standards are supported by request. When no integration exists, SETWorks provides various billing reports and CSV export options for simplifying more manual billing processes.
Features
Special Functions
Billing can be a complex process but SETWorks tries to alleviate some of that pain via specialized functions. Here are a few examples:
- Automatic Resubmission and Replacement Claims: Push one button in SETWorks and we will process all records across a billed batch and determine what records should be resubmitted and what records should be replaced to maximize payment and more easily handle ever-changing Medicaid eligibility.
- Re-Authorization processes allow SETWorks to move records to the appropriate authorization based on different rules for hours of services delivered per day and handle exceptions such as hospitalization, therapy and family visits.
- Has your funder made it impossible for you to select the correct authorization at the start of the week or month? Don’t worry! SETWorks can handle these scenarios as well and will move records to the best authorization to maximize billing.
Electronic Billing
In SETWorks electronic billing has features that are useful and necessary, making billing submission fast and targeted to the task at hand. SETWorks integrates with your funder’s eBilling software program.
- Batch submit units, dates and services
- Resubmit or void claims
- Electronic reconciliation reporting
- Built-in QA and signature authentication
Is your state system still running on software from the 80s via a green screen? Don’t worry! We’ve probably seen it before and have figured out a way to connect!
Manual Billing
SETWorks makes the process of scheduling to documentation to billing simple. There are a range of reports and invoice templates to ensure billing accuracy, improving the paperwork aspect of your important service delivery.
- Invoice for completed outcomes, milestones and benchmarks
- Invoice for hourly services
- Invoice for maintenance and transportation services
- Keep a historical record of all invoices
- Built-in QA and signature capabilities
- Export email invoices directly from SETWorks
Does your billing system only allow for manual input on maybe a first come / first serve basis? Do you need to prioritize billing for services that have a higher rate due to unit limitations? SETWorks can help in these scenarios as well!
