Physicians DataTrust uses modern medical software systems to log, adjudicate, and pay claims. Our Director of Information Systems developed and implemented a proprietary document management system designed to support and streamline our Claims operation. The Operation Support System (OSS) is a complete document management system designed to route received paper documents for appropriate processing. The document management system allows data to be kept secure, while allowing all documents received to be handled in a timely manner. The system includes QA functionality for both the images and the data entry of the images, as well as reporting and routing functions. We use Optical Character Recognition (OCR) for claims data entry to ensure quick turnaround time and high level of accuracy on all paper claims received.
Providers who prefer the paperless option utilize interactive electronic claims intermediaries, like Office Ally, Allscripts, and Smart DataSolutions to easily submit claims from their office. These intermediaries allow for easy submission and faster turnaround times. Once received, all claims, eligibility, referral and authorization records are maintained in our managed care information system, MedMC. Our claims quality control department employs Virtual Examiner, an automatic claims review system, to balance accuracy with timely response deadlines. Automated systems and review by a licensed medical professional allow Physicians DataTrust to meticulously identify fraud and abusive billing patterns, and to ensure healthcare resources are appropriately utilized.