Provident Solutions can work as your Information Technology staff or with your IT staff. With our current clients, we report to different bosses; a business owner, the CEO, the COO, a VP of Information Technology, a Systems Manager. We even work for companies who never meet us - as a third party vendor. We assist your organization with its technological opportunities and challenges as you see fit.
Email, Firewall, & Virus Protection
Secure your network with a personalized server from Provident Solutions. Our servers run on open source technology which drastically reduces your up-front cost. These servers are configured to your specifications and include email, virus protection, backups and more! Our staff can work as your IT team and happily take your call, no matter what the problem, 24 hours a day, 7 days a week.
Open Source, Low Cost
We have experience deploying email, file sharing, virus protection, and backup solutions. Our service capabilities integrate seamlessly into your existing Windows based network and can even work with the users you have already configured. We provide low cost solutions based on proven open-source products. There are no per-user or per-CPU costs associated with our system integration services.
We have experienced staff to handle data conversions for your current system or legacy data. These are often fixed-bid projects for database conversions, but we also provide services for smaller file conversions on a pay-per-service basis.
Our clients represent a wide cross section of organizations. Healthcare related enterprises make up the bulk of our clients, but they aren't the only organizations for which we provide products and services. We are often contacted by local establishments for programming and system related tasks.
Provident Solutions has provided computer related consulting in the following fields:
- Management Services
- Professional Sports
- Educational Services
- Colleges and Universities
- Claims Administration
- Claims Filing
- Patient Care Management
Provident Solutions has experience building and maintaining claim systems. We specialize in non-traditional, large management systems that sit between the payor and the provider. These systems perform any number of tasks from billing, pricing, and AR management and are built specifically to meet the client's needs.
Many of our clients have a need to price claims based on custom contracts with both the payor and provider. This could be a risk based per member, per month contract or simply a fee for service based contract. Our systems are capable of pricing claims based on fee schedules and DOS, strict contract amounts, billed amounts, or percentages of these amounts. We also have rules designed to handle risk or pass-through claims that need no pricing other than the ability to track what is owed in COB or patient responsibility balances.
Prices for claims are defined when they are received from the provider. Defining what is owed to the provider versus what the payor owes up front means that you can track both sides of your accounting with ease.
Custom Contract Management
We create a well-defined set of rules for claims pricing and administration fees. These rules are not limited to static fee schedules. We have the capability to expand the schedule by effective and term dates, percentages, and other custom rules without the need to duplicate large fee tables for any special cases. Our schedules are easily managed using online tools that are able to address these common issues without making a mess of your fee schedules. The editors typically support custom contracts for fee-for-service schedules, risk based contracts, bulk import and other special case rules.
Collecting payment from the health plan and distributing it to the provider is not always an easy task. This often involves the need to track two different accounts -- AR, used to track the what is owed from the health plan, and AP, used to track what you owe the provider. Where some claims systems only track AR and have limited abilities in terms of paying different amounts or collecting administrative fees, our software keeps track of both AR and AP on the claim service line and can report these values easily on the website or in billing, open AR/AP, or payment reports.
Each time a response is received from the health plan, this triggers an action on the provider payment side. If a payment is made from the health plan to AP, an equivalent payment, per the contract agreement, is made to the provider from AR. This acts as a built-in audit trail of your claim's billing and payment history. No detail is ever omitted or removed in the event of payment reversals, partial payments, duplicate payments, denials or refunds.
Provident Solutions has experience creating and parsing electronic claims files. We have detailed knowledge of the ANSI format and CMS guidelines. Our systems are capable of, but not limited to, sending electronic claims, reading claim acknowledgements and statuses, and claim payment processing. We can implement the following features or a subset of these features for your claims system.
One thing that saves time for our clients is the ability to validate claims before sending them to the health plan. This reduces errors and improves response time. We customize these rules so that if a problem is identified at a later date, we can simply add a new rule to the checklist before sending claims.
We can automate the exchange of claims files with a health plan or clearing house. The schedule is configurable and contains an email notification system so you can easily supervise your file transfers. This ensures that the health plan is never waiting on you to respond to denials or errors. Being able to have a centralized place to collect and manage claims files can reduce turn-around times for your claims business. We can also provide this service as an addition to an existing claims or practice management system.
ANSI 837 Claims File
Our claims system is capable of receiving claims via 837 from the providers as well as sending custom 837 files to the health plan. We are able to parse the received claims into the system for tracking and reporting. We then have the ability to take the same claims and automatically build a separate 837 file with your claim/account numbers and contracted pricing. This includes the ability to split, combine, or supplement claims as needed.
ANSI 997, 277 Acknowledgement & Status Reporting
Claim status files provided by the health plan are parsed and updated for your claims. This includes the ability to track claims that have not had an update or acknowledgement.
ANSI 835 Remittance
Our systems are able to receive 835 files and apply the payments, denials, and other explanations to the claims. We send a custom account number with the outgoing claims file so we can easily locate the claim and post payments automatically. These payments are balanced, dated, and grouped for tracking.
An electronic payment can be prepared for your providers into an outgoing 835 file. The account numbers that came with the original provider claim are used to create a custom 835 for payment. This process can be accompanied with a paper check or electronic funds transfer.
We realize that not every provider has converted their business to EDI and EFT. Our systems are capable of creating electronic claims from paper as well as printing checks and paper remittance advice (EOB's) when necessary.
Data Entry Forms
For any claims that require data entry, such as UB or HCFA forms, our systems are streamlined to make this process as quick as possible. We can populate member demographics and provider information from previous claims or eligibility records. We can also provide the same validation that exists in the electronic file since it all runs through the same processing.
Our systems also are capable of printing HCFA and UB claims onto pre-formatted forms, printing custom EOBs or other various reports. These documents are generated in a common format (PDF) to ensure compatibility. Paper alignment, orientation, and size are all configurable.
Provident Solutions has experience creating and maintaining patient care systems. These systems help you manage your patients and claims data. The goal is to create a standard framework that addresses the various requirements of the health plan.
Our systems are capable of creating flat views of your data for analysis. The views are an aggregate of your claims information called "cubes" which is a quick and easy method for data extraction. We then take this data and create graphs, spreadsheets, and the PDF documents of your choice.
Members with certain conditions that require care can be brought to your attention with a patient priority system. If your health plan is evaluating you on these conditions and cases, we can help you meet these metrics with your claims data and our reporting software.
We can create management software for organizations in charge of patient care for a large set of members, such as physician associations and ACO's. We can provide a platform for risk management that uses existing claims data to help identify areas in need of improvement. This data would be available to everyone in the form of a shared EMR system that allows providers to make notes on patients and compare their utilization numbers with their peers.
View Our Work
Example Payment Tracking
Example Dynamic Graphs
1. Who is Provident Solutions?
We are a small company based in Middle Tennessee that specializes in custom healthcare software and systems integration. We offer evaluation and programming services at a low cost as a result of our minimal overhead, small staff, and use of enterprise open source solutions.
2. How does Provident Solutions charge for its services?
We offer our services at an hourly rate which varies depending on the work required. We also offer discount pricing for those wishing to purchase a set number of hours to cover project development.
3. How do I access my data?
We typically write all of our software for the web browser. This ensures compatibility with most PC's and also reduces your installation cost for deployment and updates. Outside of the web browser, we have experience creating native PC applications, web browser/plug-in applications, PDF's, spreadsheets and more.
4. Is my data secure?
All of our work with clients is done through secure channels. We utilize the latest methods for encrypting and securing sensitive data. We are compliant with HIPAA and CMS guidelines.
5. Will there be training or documentation available?
This is up to you. We do not bill for work without your request or consent. There are no up-front or unnecessary costs associated with our work.
6. How are these services hosted? Who owns the servers?
This is also up to you. We often find that companies can save money by hosting their own software with minimal input from us. This is not always the case, however, as we host services for a number clients as well. We can work with your IT staff or as your IT staff to develop and deploy your software.
7. Can I pay my bill with PayPal?
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