By automating and integrating day-to-day accounting and financial events, SAPPHIRE Patient Financial Manager frees you and your staff to tackle data analysis and strategic budgeting, planning, and management issues that need your expertise and knowledge.

Contract Management

SAPPHIRE manages individual insurance plans, addressing specific authorization and unique provisions associated with employers. The integrated rules engine manages workflow criteria for claims timing, liability transfer, billing, insurance follow-up, collections, payment posting, and reporting.

Medical Records Maintenance

As a result of legislation regarding Diagnostic Related Groups (DRG) and reimbursement tied directly to medical diagnosis and clinical data, Medical Records Departments have experienced increased demands to abstract and report data from the patient chart for in-house statistical reporting and outside healthcare agencies. Hospitals need to supply a variety of data—from simple listings compiled from indexed material to complex statistical studies that can require months of labor-intensive tasks. The Medical Records Maintenance function provides you with the capability of maintaining and updating patients' medical records to accommodate the needs of data abstracting, retrieving, and reporting.

Medical Necessity

SAPPHIRE automatically confirms medical necessity when processing claims. The HIS verifies if a patient diagnosis (e.g., chest pain) will warrant payment of a specific test for that diagnosis (e.g., EKG).

Billing

SAPPHIRE captures charges from all clinical applications to:

• Generate claims, bills, and statements
• Prorate and coordinate benefits
• Retroactively adjust financial classes
• Support full DRG billing
• Automatically post appropriate entries to accounts receivable information

Account Follow-up

SAPPHIRE's account follow-up and statement generation include finance charge and late charge calculations.

Collections

SAPPHIRE manages workflow criteria for claims timing, liability transfer, billing, insurance follow-up, collections, collection letter timing, payment posting and reporting. Account follow-up and statement generation is flexible and easy to maintain. Finance charges and late charge calculations are possible, and all statement and collection letters formats are designed and maintained within SAPPHIRE.