• Real-Time Eligibility/Benefit Verification
• Self-Pay/Medicaid Eligibility Analysis
• Pre-Registration Eligibility/Benefits Verification
• Referrals & Precertification
• Claims Status
• Claims Addresses
• Patient Address Verification
• Credit Reporting and Scoring

WHIN delivers real-time insurance eligibility/benefit information where and when it is needed – in seconds. The result is accurate patient registrations, cleaner claims and improved net revenue.

Being able to immediately verify a patient's eligibility/benefit information at the point of patient access is critical. The only way this can be done consistently is to have a tool that is readily available, inexpensive and easy to use. WHIN-Financial is such a tool. WHIN-Financial is accessible via a browser and requires no special software and complements workflow.

• Verifies insurance eligibility and benefits in seconds
• Is very easy to learn and use
• Is accessible from any PC with a browser and Internet access

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The self-pay financial class continues to grow while still being the most difficult to collect. Many times these self-pay patients really have Medicaid coverage, making you (the provider) eligible for reimbursement. The key is identifying these patients before sending self-pay accounts to the collection agency – for them to find the easy money.

WHIN has created an electronic process for matching self-pay patients to Medicaid eligibility – using intelligent searching capabilities. WHIN identifies these patients and returns this information promptly so that a clean claim can be submitted as quickly as possible. Doing this on a monthly basis:

• Identifies self-pay accounts covered by Medicaid
• Decreases self-pay A/R
• Captures retro-eligibility (Medicaid)
• Determines accounts to be sent to collections and which can be handled in-house

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Pre-Registration Eligibility Verification is an automated process for verifying a patient's eligibility and benefits prior to a visit.

Using information captured at the time of pre-scheduling, WHIN is able to confirm patient insurance eligibility and benefits from designed payors and return this data in a format that can be imported into your Health Information System (HIS). This data can also be sorted by field and separated by "eligibility verified" and "eligibility not verified." Your staff can then focus their time on resolving the "eligibility not verified" patients prior to the visit.

• Verifies the eligibility of pre-scheduled patients
• Identifies those patients with and without eligibility
• Quick to implement and easy to maintain
• Integration advantages without the typical integration hassles (cost/time/delays)
• Supplies consistent information with real-time eligibility solution

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WHIN-Financial provides electronic submission of Referrals & Precerts.

• Compliant with the HIPAA regulation
• Provides an immediate response for outpatient and inpatient admissions
• Decrease phone calls and fax directly to a specialist or facility online
• Track all referrals and precerts submitted by provider

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WHIN-Claims Status gives you the ability to look into payors' claims systems and determine the status of your claims … within seconds!

• Searches by physician and/or patient
• Provides the payor's date of payment and a breakdown of the amount paid for the claims
• Helps provider assess claims status by providing approved or denied claims information
• Provides the claims number for easy reference

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Payor's claims addresses may change more than 4 or 5 times each year. With the click of a button this tool allows you to lookup over 25,000 local and national payor claims addresses and phone numbers. WHIN’s Claims Addresses application is continually updated and monitored to help ensure correct claims payment addresses.

Claims Addresses is simple and easy to use. The application provides multiple search options, allowing users to search by payor, network, state, and/or phone number.

Benefits:

• Reduces time spent calling payors
• Provides accurate claims addresses
• Increases billing accuracy

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WHIN and TransUnion have teamed up to offer network-based Address Verification. Search for patients’ current and previous addresses by entering either the social security number or their name and last known address.

TransUnion databases are updated twice each week, so that information is current.

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The Credit Reporting and Credit Scoring Inquiry Screens are simple and easy to use. Enter either the patient's name and last know address or the patient’s social security number. Credit information is returned in seconds.

Credit Reporting Responses Screen

• Returns a comprehensive credit history formatted for easy use
• Contains four distinct categories:
  • Indicative Information
  • Payment History
  • Public Record Information
  • Inquiry Information

Credit Scoring Response Screen

• Returns a customized score and snapshot of all activity on a patient's credit report
• Has option to display total file history or a 12-month file history
• Provides a customized scoring model developed for all organizations

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Click here if you'd like us to send you more information about WHIN-Financial.

To become a subscriber:
Call us at 414-448-1100 or 1-800-331-9446, or e-mail us.