ClaimStaker Claim Scrubbing
EHR & Practice Management
With one-click, save time and money!
Reduce denials and increase reimbursement using the industry’s
leading claim edit database!
Diagnosis Code Edits
 ICD-9 validity
o Ultimate specificity
o Secondary code suitability
o Patient gender
 E-codes
 V-codes
Procedure Code Edits
 CPT validity, including patient gender and
age
 Correct Coding Initiative (CCI) bundling
 HCPCS validity
 RVU sequencing
 Modifier usage
 Global fee periods
 PQRI
 ePrescribe incentives
Outpatient Prospective Payment System
(OPPS) Edits
 Outpatient Code Editor (OCE) validation
 Revenue/HCPCS code combinations
 Condition Code, Occurrence Code, and
Value Code checks
Medical Necessity Edits
 Part A and Part B LCD/NCD
 Proprietary (Clinically Defensible)
 E&M level of service
 Links to LCD/NCD policies
Claim-Level Technical Edits
 NPI (provider number) validity
 Accident indicators/date accuracy
 Place of service appropriateness
 Charge versus allowance analysis
 Overall proper claim completion
File Format Edits
 ANSI 837 EDI claim file format verification
 Situational segment and data element
evaluation
 Maximum/minimum field lengths
 Proper qualifier usage
 Data content accuracy
ClaimStaker…
 Improves claim validity
 Improves cash flow
 Demonstrates clinical defensibility
Payer Specific, Customizable Edits
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Enable or disable edits for specific claim
types or payers with the click of a check box
Accommodate unusual insurance and
managed care rules
Customize edits by individual payers or payer
types
Create your own rules using the “edit wizard”
E&M, eRx, and PQRS Edits
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Apply an acuity level to each ICD-9 code
Avoid compliance risks of over-coding
Prevent revenue loss from under-coding
Assists with capitalizing on eRx and PQRS
incentives
View only the applicable PQRS edits to your
practice
Detailed, Instructive Error Reporting
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Informs you of all the information necessary
to make coding corrections
Presents the error logic in easy-to-understand
terms
Provides the appropriate corrective action
when possible
Data Strategies, Inc.
CORPORATE SALES
(800) 875-0480  Fax: (858) 486-5492
[email protected]
13475 Danielson St., Suite 210
Poway, CA 92064-8858
www.MDsuite.com
TECHNICAL SUPPORT
(800) 514-3131  Fax (858) 486-5493
[email protected]
ClaimStaker Claim Scrubbing
EHR & Practice Management
How does it work?
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In post charges, you click the ClaimStaker button.
Information for all charges is sent via a secure internet connection to be analyzed by ClaimStaker.
Results are then displayed – click on any item to immediately correct any errors – PRIOR to billing!
Links are provided for errors so you can read detailed information.
Where in MDsuite can I scrub my claims?
Currently, this functionality is available in the post charges screen.
Future
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versions of MDsuite will allow you to scrub claims in more areas.
Pre-processing report during billing
EHR encounters
“Leave for Coder”
Is any personal health information sent to Alpha II ClaimStaker?
No – individually identifiable health information is not provided.
How much is it?
The fee varies according to how many providers use it.
practice.
Consult with your Sales Representative for pricing for your
How is a “provider” determined?
A provider is defined as an individual who performs services, i.e. the rendering provider.
How am I billed for this?
The fee is per provider, per year. It is billed with your annual Software Maintenance Fee. The annual fee will be
prorated based on when you elect to add the feature.
Should I buy it?
For most offices this is a simple decision – YES! The price is minimal and the saving potential is HUGE!
What is clinical defensibility?
Alpha II had a medical review board made up of doctors and nurses, go through all CPT and ICD9 codes to
create logical rules for medical necessity for non-Medicare payers.
Data Strategies, Inc.
CORPORATE SALES
(800) 875-0480  Fax: (858) 486-5492
[email protected]
13475 Danielson St., Suite 210
Poway, CA 92064-8858
www.MDsuite.com
TECHNICAL SUPPORT
(800) 514-3131  Fax (858) 486-5493
[email protected]