Problem Statement

Claim edits create manual rework before a claim can go out the door, and edits left unresolved either delay submission or, if missed, produce avoidable denials that erode the clean claim rate and push out cash collection. Workers' compensation claims price off state-mandated fee schedules, and billing them correctly requires the legacy Cerner charge code that aligns to that schedule rather than the default code on the account. Validating and swapping the code manually on each account is repetitive and easy to miss.

Automation Solution

This automation validates and replaces charge codes on workers' compensation accounts with the legacy Cerner code aligned to the applicable state-mandated fee schedule, so the claim bills correctly.