Billing Software

Customized & Compliant Tools for Accurate Billing

The Billing Module uses the data inputs from the DCI Authorization Module, the DCI Payroll Module, and the DCI Training Module to create billing files for agencies. The module also uses time entries to create billing files for providers. When integrated with the authorization and training modules, this module can create 100% billing compliance. The Billing Module runs data reconciliation against the data entries in the other modules to ensure billing will not be denied.

When fully integrated, the Billing Module ensures the following:

• Billing occurs only for correct services.
• Billing occurs only within the available authorized units.
• Billing occurs only for the correct clients.
• Billing will always occur within the hourly, daily, monthly, or annual service limits.
• Billing will occur only for services that were provided by a staff member who was 100% training compliant.
• Billing occurs only for approved services.
• Billing occurs only for time with confirmed client verification.

Electronic Data Interchange (EDI)

The DCI Billing Module has a complete Electronic Data Interchange (EDI) engine that generates billing to the MMIS. This proprietary tool can receive remittances, aggregating visits, and generating claim data.

• Incorporates program rules and requirements defined by the State to create a rules-based billing environment. This makes sure all rules related to the receipt of Medicaid funds and Medicaid claiming are followed.
• Runs data reconciliation against all data entries to ensure 100% compliance.
• Is flexible and capable of integrating with any system for billing and claims reimbursement with the appropriate upstream data validation.
• Includes processes to enable first claim submission payments. These tools help limit the need to engage with the State, MMIS, and other key stakeholders to remedy billing denials which allows for an overall more efficient billing process for all parties.
• Can send (837) files and receive (835) files as well as other billing-specific file types to ensure claims have a clean submission.
• Utilizes batching processes to transmit data.
• Supports processing of data via flat files and in multiple EDI formats, including but not limited to, XML, X12, NIEM and XML based standards for communications and integration with other environments.