Navicure® ClaimFlow™
Collect more from payers, faster, with less cost and effort.

Navicure® ClaimFlow™ allows you to collect more from payers with less effort. The solution streamlines the entire claims process from claims submission to denial and appeal management. Our easy-to-use dashboard enables you to manage eligibility, claims, remittance, rejections, denials and more from one single location. In addition, you’ll be able to track your claims through the entire process and easily identify rejections and denials that need to be addressed so that you can keep your cash flowing and prevent these problems from happening in the future.

Minimize the largest source of denied claims.

One of the most common reasons for claim rejection or denial is ineligibility. Rather than putting reimbursement at risk after a patient encounter, your registration staff can use our real-time or batch eligibility solutions to determine patient insurance eligibility prior to rendering service. With this solution, you’ll be able to:

  • Reduce costly rejections and denials by checking eligibility before patients are seen
  • Increase profitability – reduce costly write-offs
  • Improve staff productivity – eliminate manual eligibility verification
  • Increase cash collections – obtain up-to-date co-pay, co-insurance and deductible information
  • Receive real-time access to critical patient and insurance information, including coverage dates, benefit ceilings, co-pays and more

Claims Management
Pinpoint claims that need attention.

On average Navicure® clients enjoy a 98% clean-claim first-pass rate. Our powerful claims scrubber monitors all clients’ rejected claims and creates additional edits based on the rejection reasons, which increases the first-pass rate for all Navicure users. With our user-friendly dashboard, you’ll be able to easily identify the 2% of claims that may need your attention, quickly make any necessary changes and keep your claims and cash flowing. You can also:

  • Reduce AR days by correcting and resubmitting claims online
  • Lower administrative costs by using the solutions for all your claim needs: Electronic, Paper, Primary, Secondary, Professional, and Institutional
  • Increase clean-claim rate with our Medical Necessity and CCI Edits
  • Categorize your rejected claims with our Rejection Category Report, which enables you to identify and work rejected claims easily and efficiently and quantify the most common rejections so you can prevent them in the future
  • Simplify claims management by tracking claims every step of the way using our dashboard and search tools
  • Create secondaries with ease, including coordination of benefits information

Remittance Management
Post remits quickly and easily.

Receive electronic remittance advice (ERA) from national and regional payers and automatically post them to a HIPAA-compliant practice management system, saving you time and reducing data entry errors. In addition, with the remittance tools available in Navicure® ClaimFlow™ you’ll be able to:

  • Split the ERA file in a way that best supports your workflow
  • Receive your portion of an ERA file electronically with Navicure® ERA Bridge™ despite sharing a tax ID

Denial and Appeal Management
Appeal denied claims in minutes, not hours.

Denied claims are a fact of life. Fortunately with Navicure® ClaimFlow’s™ powerful denial and appeal management tool, Navicure® Remittance Manager™, you’ll be prepared to handle them. Use the tool to:

  • Streamline your denial workflow with personalized work lists for role-based user-specific reporting that fits your practice
  • Find claims and payments quickly with our extensive search tools, using criteria most important to you
  • Identify the most common denial reasons so that you can prevent them from happening in the future
  • Easily research denied claims with access to both denial reasons and remarks
  • Appeal denied claims easily, using pre-populated letters and payer forms

Paper Patient Statements
When electronic statements aren’t an option.

It’s unlikely that you’ll be able to send 100% of your patient statements electronically, so you’ll need to be prepared to process paper patient statements.

Navicure® can help with the hassle of printing, sorting, folding, stuffing and mailing paper statements. Use Navicure’s® professional, customized paper patient statements solution to:

  • Save money on inventory, equipment, maintenance and supply costs
  • Increase productivity by eliminating printing and mailing of statements, allowing your organization to focus on other important, revenue generating tasks
  • Improve the patient experience by providing your patients with concise, easy-to-read statements
  • Achieve faster delivery times, which equals faster payments and decreased days in AR

Navicure® Coding Resource™
Be a coding expert or speak to one.

With coding and compliance guidelines constantly changing, it can be difficult to ensure that you are submitting accurate claims and being reimbursed correctly. Navicure® Coding Resource™ makes finding the correct diagnosis codes, CPT/HCPCS and modifiers easy.

With this solution, you’ll be able to:

  • Access the most up-to-date coding information and stay on top of Medicare compliance regulations
  • Get expert coding advice from coding staff and colleagues in other medical practices
  • Enable your coders to work more efficiently
  • Reduce AR days by preventing payer rejections and denials
  • Compare your practice’s list rates with current CMS published rates using benchmark data

Enhanced Edits
Custom edits to meet your specifications.

With Navicure’s® medical necessity and National Correct Coding Initiative edits, practices can prevent reimbursement disruptions. You’ll be alerted to possibility problems immediately – before the claim is forwarded to the payer. This means you’ll achieve a better first-pass rate and reduced AR days. Plus, if your practice requires unique edits to meet internal needs, Navicure will develop custom edits to your specifications.