DataNova for Healthcare and Dispensing
Collect what every insurer owes you, with every invoice supported and every denial answered on time.
DataNova matches the order, the authorization, what was delivered and what was billed before filing, tracks every denial until it is resolved and applies every payment. Our engineers put it to work on the clinical system and billing you already have.
Helping pharmacy benefit operators and healthcare providers bill what they deliver, answer every denial on time and collect what each insurer owes them.
Every invoice, supported before filing.
What was ordered, authorized, dispensed and contracted is matched before the invoice is issued, and the service record goes out validated.
Every denial, answered on time.
Notices from every insurer land in one inbox, with the deadline counted and the status of every item.
Every payment, applied.
The insurer’s payment is matched with its invoices, and each payer’s receivables are reconciled.
What changes
What happens in the revenue cycle today, and what happens with DataNova.
Each row is money that stays between the counter and receivables.
The authorization is checked against the order at several desks, and the difference shows up with the patient at the counter.
Order, authorization and prescription are matched before the patient arrives.
A presentation different from the authorized one is dispensed, and the insurer denies it over dosage form.
The authorized and dispensed drug codes are compared before billing.
Each denial is typed three times, and its deadline is kept in a notebook.
Denials from every insurer land in one inbox with their deadline counted.
The RIPS service record bounces over a typo while the filing deadline runs.
The record is validated before it goes out, and every invoice carries its filing clock.
The insurer pays without saying which invoices it covers, and the payment waits until receivables works it out.
The bank statement and payment detail are matched with the invoices, and the payment is applied.
Each insurer’s statement is matched by hand, without separating what was filed, denied and paid.
Every difference is classified against the payer’s statement, with the reconciliation record drafted.
What it looks like
Every denial in one inbox, with its deadline.
Notices from every insurer land in one place, without duplicates, with the reason, the deadline counted with holidays and the status of each item until it is lifted or upheld.
| Reason | Invoice | Deadline | Status |
|---|---|---|---|
| Different dosage form | Due this week | To answer | |
| Expired authorization | Due today | To answer | |
| Incomplete support | On time | Answered | |
| Rate differs from contract | On time | Lifted | |
| Returned over service record | On time | Refiled |
On what you already have
DataNova runs on the clinical system, billing and each insurer’s portal.
Our engineers connect DataNova to the systems and files you already have, with nothing to migrate. The platform does the matching, and your team handles the differences.
- Clinical system or ERP
- E-invoicing
- RIPS validator
- MIPRES prescriptions
- Insurer portals
- Online banking
- Excel and email
The revenue cycle
Six stages, from authorization to collection.
Start with the stage that costs you most, because each one works on its own.
- 01Contracting and authorization
- 02Purchasing and supply
- 03Dispensing and care
- 04Billing and filing
- 05Denials and returns
- 06Receivables and treasury
- Stage 1 of 6
Contracting and authorization
Validate each authorization once, before the patient arrives. Every contract’s rates sit in one table, and order, authorization and prescription are matched on their own.
Single fee schedule
One table by contract, procedure code and drug code with its validity, feeding the check of every invoice.
Authorizations up to date
Schedule, order, authorization and prescription matched, with what is expired or different flagged.
- Stage 2 of 6
Purchasing and supply
Buy on real consumption and recover every advance. The reorder point comes from each item’s consumption, and every laboratory credit note is applied.
Reorder point
Consumption and lead time by supplier, with warnings for expiring and slow-moving items.
Advance matching
Each advance to a laboratory is matched with its invoice, and the credit note is applied.
- Stage 3 of 6
Dispensing and care
Deliver what was authorized and bill what was delivered. What was sent, administered and returned is reconciled by admission, and the cold chain warns of every excursion.
Reconciliation by admission
What was sent, administered and returned in each admission, with the differences listed.
Cold chain
Readings from the temperature loggers, with a warning for every excursion and the affected lot.
- Stage 4 of 6
Billing and filing
File within the deadline, with every invoice supported. The invoice is matched against the order, the authorization and the contract before it is issued, and the service record goes out validated.
Invoice pre-check
What was ordered, dispensed, authorized and contracted is matched before the invoice is issued.
Filing clock
Each invoice with its electronic invoice code, its validation, its filing number and the days left to the deadline.
- Stage 5 of 6
Denials and returns
Answer every denial on time and know which ones were lifted. All notices land in one inbox with their deadline, and every item ends with its final status.
Single denials inbox
Notices from every insurer in one place, without duplicates and with the deadline counted with holidays.
Final denial status
Each item marked as upheld or lifted, with the reconciliation book for each insurer ready.
- Stage 6 of 6
Receivables and treasury
Apply every payment and reconcile with every insurer. The payment is matched with its invoices by tax ID, amount and reference, and every difference is classified for the record.
Cash application
The bank statement and the payment detail matched by tax ID, amount and reference, with the receipt proposed.
Reconciliation by insurer
Each difference classified against the payer’s statement, with the draft reconciliation record.
Every figure with its source
From days of receivables down to the patient’s authorization.
Any figure in the board report opens up to the order that started it.
- 01
Board report
Days of receivables
- 02
Aging report
Reconciled with each insurer
- 03
Filed invoice
With its service record, its denial and its payment applied
- 04
Order and authorization
And the patient’s dispensing record
The software, in healthcare.
- DataNovaAuthorizations, filing, denials and receivables, on the clinical system and billing you already have./01
- BrainNovaEach step of the revenue cycle told by authorization staff, billers, auditors and pharmacists, cited by name and role./02
- SectorNovaYour figures against similar providers’, with a warning when they are not comparable, such as an outpatient clinic against a hospital./03
How it starts
One revenue cycle task in production, with our engineers.
Pick one task, connect the systems behind it, and put it to work on your real data.
- 01
Pick the task
Usually applying insurer payments, with the receivables dashboard for management.
- 02
Connect the systems
Our engineers connect bank statements, payment details and billing, with the files the payer already sends.
- 03
Put it to work
The task runs on real data, and the next one is built on the same model.
Other industries
- Private equity
LP management, portfolio companies and DDQs
- Infrastructure and concessions
Progress certificates, supplier statements and project cost
- Education
Tuition, receivables and each school’s board report
- Manufacturing and distribution
Real cost, inventory and margin by customer
About XPTNova
XPTNova is a Colombian software company. Our engineers work inside each client until every process runs in production. Each client’s data is isolated from every other client’s, runs in our cloud or in yours, and is never used to train models.
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Start with the stage that costs you most.
Pick one task, we connect the systems behind it, and our engineers put it in production.