SHAPE ClaimRemedy
Real Time Eligibility	Claim Editor
SHAPE IDentify HomeFeaturesBenefitsTechnical	SHAPE Edit HomeFeaturesBenefitsTechnical

Supported Edits:

- All seven WEDI/SNIP recommended levels
- Procedure coding to check for compliance with CCI policies, gender and age restrictions
- Medical necessity using CPT/ICD9 crosswalk data and the ordering of procedures for maximum reimbursement
- Diagnosis coding using valid primary diagnoses, proper levels of specificity and the inclusion and ordering of any required accompanying diagnoses
- Situational/conditional fields and service/procedure related fields are checked to see if they are required and reported
- Logical date-field relationships (e.g., date of onset occurs on or before date of service)
- Payor-specific published rules editing (Medicare, Medicaid, commercial carriers, etc.)
- Payor-specific unpublished rules editing

Transactional Analysis

Click to view partial comparative analysis of similar products (Microsoft Excel File)