Coeur Rule Engine

Coeur Rule Engine is an Innovative & Intelligent State-of-the-art Software application system designed to reduce technical inefficiencies and improve performance of RCM functions. A fully standalone and integrate able rule engine delivering improved productivity, operational efficiency and financial performance. Coeur enables you to review your encounters against edits and helps take complete charge of your RCM functions.

Key Insights
Scrubber Overview:-
  • Based on XML validation
  • Manual entry of ICD and CPT combinations without any XML or excelinputs
  • Quick reference tool for individual coder
OP Coding(applicable to IP/DC also):-
  • National correct coding initiative (NCCI) edits.
  • Medicaly unlikely edits(MUE).
  • Missing primary code.
  • Unacceptable ICD combinations.
  • Unacceptable primary diagnosis.
  • Pregnancy trimester conflict.
  • Missing combination ICDs.
  • Age and gender discrepancies.
  • Encounter type error for office visit or Emergency visit (op only).
  • ICD Sequencing check.
  • E/M Coded with minor procedures (OP only).
  • Lab panel codes unbundled.
  • Anatomical site of wound ICD conflicts the repair CPT.
  • Laterality coding conflict with Reason for visit and coded Pdx or Sdx (OP only)
  • Missing external cause codes for Injury ICDs
  • E/M enhancement rules based on coded ICDs and billed services (OP only)
  • COVID related rules including vaccination (OP only)
  • Daman and Thiqa paracetamol infusion to be coded as injection (OP only)
  • Guidance CPT coded without relevant Procedure CPT and vise versa
  • Check for fracture care procedure done or not for the coded fracture ICD
  • Missing pre-approval
  • Space between Member ID
  • Non covered diagnosis (OP only)
  • Non covered services (OP only)
  • Covid under base insurance
  • Clinician ID mismatch (GD-GT)
  • Multiple approval number
  • Member ID format
  • Limit exceeding (OP only)
  • Missing drug code for the CPT (OP only)
IP Coding/Submission:-
  • DRG validation against coded ICD and CPT
  • Mandatory line item validation against coded CC/MCC / Pdx
  • Separate procedure vs bundled CPT codes validations
  • PTCA procedure vs ICD codes validations
  • Medical indication validation for Coded CPT vs ICD
  • EM codes errors validations like missing , duplicate , wrong EM codes
  • Time validation for DC services 25 & 24
  • Major and Minor procedure validation with OT services
  • Service codes error validation as per Transfer and DC encounter
  • Room & Board codes validation like missing , duplicate and wrong R&B according to services rendered
  • Encounter start and end type errors
  • High cost HCPCS validation for Add on 98
  • Encounter specific ICD codes validation like LAMA, Deceased , Encounter for Chemo.. Etc
  • DOS error validation against CPT and services codes
  • Anesthesia codes error like unit error , missing anesthesia , wrong anesthesia
  • DC / Transfer perdiem billing related errors - identifying billable / non billable errors
  • HCPCS codes billing errors - Multiple quantity merging in HIS
  • HCPCS more than one quantity & Average value less than 1500
  • Invoice attachment missing against HCPCS
  • 99 service code validation & Approval validation
Integrate Scrubber at coding and auditing level:-
  • Coding Cancellation Audit tool
  • Uploading an excel containing coded and cancelled services of SAP and auditing by system with inbuilt rules
  • Helps to identify any revenue loss and Improves coding quality
  • Reduces time and effort in manual audits
  • System to validate usual scrubber validation based on available ICD and CPT in excel and another separate validation of cancellation reason. Finally giving out error message for every case