4eGuru released
Online EDI claim clearinghouse portal software, flow, claim forms' format & protocol are compliant with State of California Medi-cal (CMS1500)/PCHDP(PM160) form

Starting with the basic Electronic Health Record and advanced input technology an Electronic Health Record becomes developed at a newborn’s early age and as a standardized HL7 computer file, will be able to live with individuals for their lifetime. 

Medical specialties are progressing in their development and addition of related imaging techniques, drug usage and prescription records matching the development of new treatment techniques. Yet, despite the advancements made, some elements in the practice have not improved, namely billing, since there has been a wide disparity in formats for submission of claims statements to insurance companies, federal, state and local offices for efficient compensation to physician individual and group practices. 

This problem has also been addressed by 4eGuru Inc. with the integration of the claims billing process with the Electronic Health record system with a new software module called “CHDPGATEWAY” enabling direct statement preparation and electronic transmission to government offices immediately following visits with unnecessary clerical tasks which now consume the time and resources of the physician, nurse practitioner, assistants, and clerical staff, improving the productivity of all and allowing more patients to be treated while providing much more effective reimbursement.

The financial benefits far outweigh the cost of installing and utilizing “CHDPGATEWAY”. Its ease of use has been proven through many man-months of use in targeted physician installations. Training and support during the transition from the manual clerical methods now in use is provided by 4eGuru to ensure complete operational facility by physicians and staff before the system goes fully operational. Additional support and troubleshooting of is provided by local staff, not some remote e-mail address.

4eGuru Inc.’s “CHDPGATEWAY” online submission flow and module are compliant with California State Department of Health Care Services Medi-Cal standard. It supports online batch claim submission (CHDP-Green form or PM160) and prepares paper print claim submission forms if required, without going through any third party or claim clearinghouse.

A cost-benefit estimate has been prepared below in moving to 4eGuru’s Electronic Health Record and using the “CHDPGATEWAY” automatic online claim submittal method.

CHDP Paper Claim vs. Online Web Submission Claim Cost Comparison:

The present CHDP paper claim form completed by manual entry and mail submission is not the optimum method to submit physician visit payment claims compared to electronic paper-less technology.  As shown below, economic benefits can be quickly and easily realized by converting a paper-based medical insurance payment claim or billing to a fully integrated, paperless record system as provided by 4eGuru with the “CHDPGATEWAY” claim module, with a breakeven period of about 6 months. Further as a result of the ARRA stimulus program which provides a reimbursement incentive for conversion to electronic technology the cost of conversion results in an additional financial payoff for a four year time period.

How much is Physician time worth?

What if you could save an hour or two per day? If you currently submit CHDP paper forms manually, your office is wasting a valuable resource “Time”,  whose use when optimized, can generate cost savings, enhanced revenues and more efficient office operations.

For a typical Physician or Multi-physician Practice cases, billing paper flows follow the procedure in the diagram above; not only does the individual physician have to take the time to write the notes for a biller or and/or their assistant, but the Practice has to forward the visit data in paper summary form to the Billing Office which generates a paper form, copies, packages and mails the billing information to the state in the case of Medi-Cal or to an insurance company. In these cases, labor time savings would occur if data electronically entered an qualified by the Doctor directly could bypass the unnecessary steps of manual entry by the Assistant and then forwarding pre-claim paperwork to generate the claim forms in proper format forwarding the data to the Billing Office and onward.  Manual handling of all the data induces errors, requires filing copies, stuffing envelopes mailing and recording the transactions for follow-up as required.  The analysis below demonstrates how an Electronic Health Record combined electronic forms handling creates major financials reward and many intangible benefits to the practice.

Time and Money Saving Steps - For CHDP Claims:

A.Physician and Provider side:

Doctor and Assistants Activities

A #1. Practice Statistics –Biller/Assistant:

Note: In third and fourth years there may be software and hardware upgrades so
operational savings are conservatively reduced.

The “CHDPGATEWAY” software suite is a fully integrated and robust solution tying together the patient information and clinical examination and procedure room to the practice management aspects of the medical office which include the reporting, insurance billing, payment receipt and patient reporting.The software operates as a Web-based and Client-Server application, which runs on all computer platforms including Windows- XP, Vista or Windows 7 servers, Linux. Mac OS X, and on all Internet Web-browsers. These include Internet Explorer/Firefox, Mozilla, Safari, and on all devices such as desktops, laptops, tablet computers, iPhones, and other PDA devices. User can maintain full administrative management control to maintain patient data privacy over all applications by restricting access only to appropriate authorized and authenticated levels.

“CHDPGATEWAY” Medical software product improves office work efficiency, lowering office costs, makes patient record storage and retrieval flow more easily and with less error, enabling the entire office to become virtually paperless.