FAQs & Support Topics

SPSI Services FAQs

Business Analytics for Revenue Cycle Management Overview

SPSI is excited to announce the release of the latest version of our Business Analytics Tool.  The Analytics Tool is a hierarchical based display of our client's revenue cycle.  For our Tier 3 clients who transmit claims and remittances, we are in a perfect position to provide an independent verification of their revenue cycle. The Analytics Tool, a data mining type tool, provides our clients the ability to evaluate their revenue cycle from various perspectives independent of their practice management system.   


Our clients can select from a list of business perspectives such as Claim Processing Results, Payors, Service Locations and Rendering Providers and compare these perspectives relationship to each other over a selected time period.


An example might be; Show me my Claim Volume including Rejections for each Payor at each Service Location. Or what is my Claim Dollars, per Rendering Provider, per Payor, per Service Location. 


The Analytics Tool is designed to assist management in evaluating business trends over a defined time period while also providing an independent 3rd Party evaluation of their revenue cycle for either internal or external negotiations.   


For more information on the SPSI Analytics Tool, please contact your local SPSI representative. 

Business Analytics Terminology


Two quick examples below  


Can I receive ERAs (Electronic Remittance Advice)?

Sending in claims is the easy part of electronic billing. More complicated and involved is getting set up to receive ERAs (Electronic Remittance Advice) back from the payer to close the revenue cycle. SPSI maintains an active database of all of the payers we work with including instructions to register to receive ERA files from the payer. We have years of experience working with hundreds of payers throughout the country and will support you throughout the registration process.

Can SPSI help with Revenue Cycle Management?

SPSI offers detailed reports and analytic data to help you close your revenue cycle and improve your revenue cycle management efficiency. The metrics offered by SPSI include: average days in A/R, outstanding balances by dollars and claim count, claim rejection rates, claim denial rates and amount billed vs. amount paid. SPSI’s local representatives are able to work with your organization to modify and improve existing practices in order to receive compensation for services rendered as soon as possible.

What if I don't have a Practice Management System (online claim entry)?

Practice management systems are software systems specifically designed to generate claim files (837 files) in the appropriate format to send claims to payers. Practice management systems are costly and sometimes prohibitive for smaller practices. SPSI gives you the option of sending in batch claim files, either professional or institutional, or using our OnLine Claim Entry tool.

The OnLine Claim Entry tool is often utilized by smaller clients with lower claim volume and will allow you to send your billing claims electronically without the need for an expensive practice management system. SPSI’s local representatives are available to help set up the tool and train your staff on its use. We also have detailed guides available for reference to help you maximize the efficiency of the system.


Do SPSI services include Eligibility Verification?

Verifying active coverage for patients prior to rendering services is more important than ever before.  SPSI has a robust tool to verify insurance coverage for patients in regular intervals and/or according to upcoming appointments.  Our system utilizes a process we refer to as cascading to follow the trail of likely coverage in instances where the patient does not have coverage with the original designated payer.  For instance, if we do not find active coverage with the primary insurer, but the patient is over 65, we will automatically check Medicare for coverage.

SPSI also offers the ability to do individual eligibility checks in real time in the event of walk-in patients or last-minute scheduling.  One of the first, and most vital steps, in maintaining an efficient revenue cycle is verifying insurance coverage prior to providing services.  SPSI has you covered. 


How does pricing for SPSI services work?

SPSI's cost structure is 100% based on the utilization of our services. There are separate costs associated with sending in claims, receiving electronic remittances, and verifying patient eligibility. We utilize a tiered pricing structure that offers discounts for larger providers who submit a high volume of claims. Please contact SPSI's local representatives for more information.

Does SPSI provide consulting?

SPSI is more than just a clearinghouse, we are EDI consultants. We are committed to supporting your organization throughout setup, implementation and any issues you encounter while sending claims through SPSI. Unlike many other clearinghouse organizations, we have a local presence in Arizona and staff with over 20 years of public behavioral health work experience. We offer training and support to our clients as well as online videos and a comprehensive FAQ section on our website that is updated regularly as additional information becomes available. Our local office focuses solely on Arizona providers and as such, bring unparalleled expertise to our clients.

Is SPSI a clearinghouse?

SPSI does far more than the average clearinghouse. In fact, we do not think of ourselves as a clearinghouse, despite serving that function. We are EDI consultants. The difference is the support you will receive from local representatives with 20+ years of combined EDI healthcare experience. We offer training, education and ongoing support for our customers. In addition, we provide advanced statistics, offer eligibility checking and maintain a robust library of videos and resources to help your organization maximize your billing efficiency and minimize the time it takes to get paid for the services you provide.


Southwestern Provider Services, Inc.

2350 Airport Freeway, Suite 410, Bedford, TX 76022

817-684-8500 - Office