Claims Management
Claims management is the systematic process of handling healthcare claims from initial submission to final resolution. It ensures that healthcare providers receive accurate and timely reimbursement for services rendered. This process encompasses several key functions: preparing claims with the necessary documentation and accurate coding of diagnoses and procedures, submitting these claims to insurance companies or other payers, tracking the status of claims to ensure they are processed efficiently, addressing any issues or denials that arise, and posting payments once claims are approved.
Product Usage: Canvas is primarily used for clinical documentation and revenue cycle management, particularly through the creation of robust note templates.
Strengths: The product offers significant customizability in note templates, is straightforward to use, streamlines charting processes for all users and is ideally suited for smaller operations.
Weaknesses: The interface could use more display customization options, additional custom alert options necessary to notify part-time workers beyond basic notifications, and will eventually need a more comprehensive RCM system as organization grows.
Overall Judgement: Choosing Canvas was the right decision for the company, due to its superior customizability, seamless integrations, proactive bug resolution, and overall stability for their specific needs and company size.
Product Usage: Canvas is used for documenting patient assessments, managing demographics and scheduling, and facilitating inbound and outbound faxes.
Strengths: Canvas has excellent extensibility for integration with other systems and a user-friendly interface, and its automation features significantly improve documentation speed.
Weaknesses: Canvas’s management of images and documents could be improved, with clinical and administrative materials needing to be accessible in a single location.
Overall Judgment: The reviewer is highly satisfied with Canvas, praising its user-friendly interface, extendibility for integration, automation features, and responsive support, despite some room for improvement in image and document management.
Product Usage: Canvas is utilized across medical and therapy teams for tasks such as medical note documentation, lab result management, controlled substance prescription, and support for both individual and group therapy notes.
Strengths: Canvas provides a high degree of flexibility through its APIs and SDKs, allows customization for a user-centric experience, and provides exceptional support from their team.
Weaknesses: The platform currently lacks granularity in workflows and does not fit well with the group notes typically used in behavioral health, although the company is working on these issues.
Overall Judgment: Despite some issues, Canvas is a reliable, bug-free tool that delivers on most needs and allows in-house feature-building. It was the right choice due to its high degree of customization, exceptional support, and straightforward pricing model.
Product Usage: Candid is mainly used for post-visit claims adjudication, including claim submission, payment posting, denial management, accounts receivable, and reporting.
Strengths: The product offers a clear user interface, sufficient denial management functionality, responsive customer service and is more cost-effective compared to competitors.
Weaknesses: The product lacks the ability to bulk edit claims and some configuration options are not available to end users but must be done by their engineering team.
Overall Judgment: Despite minor areas for improvement, the product is a valuable, cost-effective solution to revenue cycle management, with excellent customer service and a straightforward user interface.
Product Usage: The product is used for back-end revenue cycle processes, from claim submission to payer and patient payment reconciliation.
Strengths: The product is flexible, accepts APIs, and works with a variety of claim formats.
Weaknesses: The product is a startup, meaning they are still building and developing certain features that established products already have.
Overall Judgment: The reviewer deemed their choice of Candid Health to be the right one as it provides flexibility and partnership that other mature products might not offer.
Product Usage: Canvas’s EHR is used for scheduling patient appointments, logging activities such as phone calls, visits, changes to a patient’s profile, condition and history, and it is also used for telehealth appointments and claims generation and management.
Strengths: Canvas’s strengths lie in its flexibility and customization capabilities, its functionality that allows users to create automations based on actions or notes in a patient’s chart and its robust API documentation and integration features.
Weaknesses: Areas where Canvas falls short include the management and generation of claims, tracking patient risk adjustment and quality measures, and also navigating their backend data for reporting purposes; additionally, the system sometimes experiences bugs and freezes.
Overall Judgment: Despite some limitations and issues, Canvas is a generally stable Electronic Health Record system that provides a higher degree of customization and flexibility than other comparable systems, and it is well suited to those with technical know-how who are comfortable with configuring a system to suit their needs.
Product Usage: Canvas used for recording chart notes, storing lab information, prescribing medications, conducting lab orders when available, and executing billing tasks.
Strengths: The product offers a reliable platform with automation functionality, the ability to easily identify the correct pharmacies for medication orders, and a flexible tasking feature.
Weaknesses: There are limitations with the invoicing system, reporting capabilities, communication tools among providers, medication history tracking, and tasking functionality is still basic.
Overall Judgment: The reviewers are generally positive towards the product, praising its reliability, automations, and customizable tooling; despite recognizing improvements could be made in the billing, reporting, and task features.
Product Usage: Canvas is being used as the company’s electronic medical record for charts and billing, recent usage of its task management feature has been introduced, and scheduling feature is being considered.
Strengths: The interface is user-friendly, the task management feature is effective for managing workload and workflow, and the autosave feature is appreciated.
Weaknesses: The knowledge center is not as helpful as it could be, locating specific settings can be challenging for administrators, command-driven entries can slow down workflow for providers, and the limitation in dashboard field customizations obstructs quick information access.
Overall Judgment: Despite identified areas for improvement, majority feedback has been positive, particularly when considering a shift from their previous EMR system, Athena, and would recommend Canvas with noted considerations.
Product Usage: Canvas is primarily used for managing patients’ clinical charts, creating claims, and dealing with patients’ claims and profiles.
Strengths: Canvas offers more visibility and a clearer workflow when dealing with patients’ claims and profiles compared to previous product.
Weaknesses: Canvas has some issues with system setup, such as wrong population of multiple locations in script ordering and missing data fields when using the claim edit feature. However, these issues are believed to be due to user error and not Canvas itself.
Overall Judgment: Overall, the product is praised for its ease of use and customization options, with a recommendation from the review to take full advantage of its capabilities.
Product Usage: Candid Health is used to submit claims, handle EFT/ERA and EDI enrollments, perform preliminary checks on claims, and manage the claims process through an integrated workflow.
Strengths: Candid Health’s key strengths include a highly responsive team, a tech-focused approach, and a flexible rules engine.
Weaknesses: Ambiguity in service scope was a challenge initially which led to some confusion about responsibilities, the CSV export feature has been less reliable, and larger-scale operations may want to bring certain services in-house to handle higher complexity.
Overall Judgment: Candid Health comes highly recommended for its high-quality sales process, support, and account management, with particularly positive remarks on its ability to improve workflows and its desire to grow with customer base.
Product Usage: Canvas is used for charting, patient management, claims tracking, scheduling and sending reminders and integrates with telehealth through Doxy.me for video appointments.
Strengths: Canvas offers real-time access to data, flexible configurations, protocols for tracking patient needs, and a robust FHIR API which allows extensive customization and integration capabilities.
Weaknesses: Areas for improvement include high user interface sophistication, limited revenue cycle management functionality, and a more structured approach to tasking.
Overall Judgment: Canvas, described as the Salesforce of EMRs, is highly appreciated for its emphasis on allowing users to build their features and regular performance improvements, despite a few bug encounters.
Product Usage: Canvas is primarily used by the customer’s care coordination team, social workers, and nurses, as well as insurance navigation staff and genetic counselors for structured and unstructured documentation.
Strengths: Canvas’s strengths lie in its customization and flexibility, Canvas’s attentive responses to customer feedback, and impressive ongoing efforts to improve features and customer experience.
Weaknesses: Despite its strengths, Canvas has some limitations, such as its handling of reporting features, integration with Claim.MD, a not fully-featured scheduling and messaging platform, and a manual provider directory feature.
Overall Judgment: Overall, Canvas has been a good choice for the company, providing valuable features and demonstrating strong product growth over time.
Product Usage: This reviewer uses Canvas for managing detailed documentation and maintaining clinical records for patients in a virtual specialty clinic.
Strengths: Canvas’s simplicity, efficient clinical notes, and modern UI are highlighted strengths of the product.
Weaknesses: The reviewer pointed out the limited and unreliable API functionality and the product’s presumption of a standard clinical model as weaknesses.
Overall Judgment: Despite its limitations, the reviewer believes that Canvas may be a suitable tool for organizations with basic clinical documentation needs.
Product Usage: The product has been used for about a year and a half for revenue cycle management and it is adapted for scaling up operations, including new features like remote patient monitoring-based billing.
Strengths: Its expertise, understanding of venture-backed companies, scalability, and tech focus made it stand out from the competition; it also provides proactive services and handles issues effectively, even offering support for troubleshooting.
Weaknesses: The product had minor issues which were promptly addressed with transparency; there were also some gaps in functionality which, though identified and prioritized by the company, led to delays in delivery.
Overall Judgment: The reviewer has had a positive experience with the product and its performance, communication, and support from the vendors, considering it to be one of the best vendors in delivering value from their product.
Product Usage: The product, Canvas, was used as an Electronic Health Record (EHR) and a care management system for non-clinicians and nurse practitioners in a tech-enabled service provider for chronic care management.
Strengths: The product was easy to customize, quick and collaborative to implement, and priced competitively.
Weaknesses: The product experienced frequent performance issues, had limited capabilities, lacked robust APIs, and struggled with scheduling and patient data segregation.
Overall Judgment: Despite the ease of initial setup and customization, the persistent technical issues and a lack of certain crucial functionality led to platform migration.
Product Usage: Apero was primarily used to power all backend aspects of our Revenue Cycle Management (RCM) process, from claim submission to reporting.
Strengths: Apero excels in offering granular tracking and reporting on each individual claim throughout the RCM lifecycle.
Weaknesses: While offering a robust solution, Apero could further improve its product by adding higher-level summary features or more visually appealing information displays.
Overall Judgment: The company was satisfied with Apero due to its tech-forward approach, responsive customer service, and strategic partnership attitude.