Providers, insurance companies, managed care companies, claims review companies, state and federal agencies—they all need to generate clean, compliant and accurate claims for a broad variety of patient types.
Industry-wide payment reform means the number of state and commercial payment programs continues to grow. Each patient type and payer brings a unique set of grouping and compliance rules and reimbursement rates. These rules and rates can change often to reflect a continual need to control health care costs.
When you tally all the different patient types and payers, it’s nearly impossible to get the claims processing tools you need to address them all and always stay on top of the latest changes.
3M Core Grouping Software is a computerized application that sets a new standard for efficiently and effectively processing claims data. With 3M’s proven grouping, editing and reimbursement calculation at its core, the software classifies patients, evaluates the accuracy and completeness of the clinical data, identifies potential errors and calculates the expected reimbursement. The software includes a number of continually-updated grouping methodologies, editing components and reimbursement formulas delivered in a single, comprehensive tool that can help you:
The 3M Core Grouping Software is written as a transaction processor, with no database storage or reporting facility. Output includes a series of individual:
By customizing the 3M Core Grouping Software, you can also:
The 3M Core Grouping Software supports a traditional batch process—input of a fixed length, delimited, or 837i file and output of a fixed length or delimited file—or an interactive interface mode.
Batch processing handles volumes of records efficiently, while interactive interface mode lets you enter, modify and process individual claims and review the output from the grouping and reimbursement calculation.
The software is adaptable and scalable and can operate standalone or networked (file server and client workstation) on a Microsoft Windows-based PC. Refer to the 3M Core Grouping Software Configuration Sheet for specific information on hardware and software requirements.
The 3M Core Grouping Software can be licensed with a variety of inpatient and outpatient grouping methodologies, editing components, and numerous state and payer-specific reimbursements. Additional capabilities are available when licensed with the 3M Medical Necessity edits and 3M™ Pricer Tables.
With 3M support, clients can install and configure the 3M Core Grouping Software themselves. As the Centers for Medicare & Medicaid and other regulatory agencies implement new policies or issue regulatory updates, 3M provides the corresponding software updates to licensed clients via downloadable updates and documentation from our client only website. 3M customer support representatives are available by phone or online to assist you during and after implementation and updates.
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