Payor Greenlight System (PGS) performs a real-time compliance assessment based on your designated payor’s reimbursement criteria.
Payor Greenlight System (PGS) evaluates your claims for medical necessity and compliance BEFORE submission.
PGS flags compliance issues before submission, reducing avoidable denials and minimizing lost revenue.
Lower rejection rates mean fewer rework efforts, less administrative burden, and improved efficiency without additional staffing.
By ensuring claims are correct from the start, PGS speeds up fulfillment and shortens cycle times.
Quickly check for missing insurance and validate Blue Cross Blue Shield prefixes to ensure correct routing of orders and billing.
PGS’s Preflight Report shows HCPC codes found within your funding packet, and suggests relevant HCPCs that are missing.
Know instantly that your claim is qualified! We provide an overview on which criteria Pass vs. Fail, plus a summarized explanation for claim errors.
Wanting to know more about your results? We provide detailed Q&As to answer every question your payor would ask on the claim. This sets you up for success on any future appeals!
This AI was built to be the ultimate advocate for your reimbursement team. With payors constantly approving your claims, you can accelerate order processing, avoid deferrals, minimize write offs, you can prove your accuracy on audits and appeals.
PGS is an AI-driven compliance solution for DME providers, automatically assessing each claim for compliance and completeness with the designated payor’s reimbursement rules. It will provide an overall "Pass" or "Fail" determination on the order’s likelihood of approval and supply detailed reasons for the assessment. PGS integrates seamlessly into the DME provider’s existing workflows, ensuring minimal disruption while maximizing efficiency and accuracy.
The Preflight Report is the output of PGS’s compliance check, assessing claim completeness and medical necessity. It provides a Pass/Fail rating, highlights HCPCs needing review, and offers both short and detailed explanations. Plus, it includes a comprehensive Q&A covering every question your claim may receive from payors.
In addition to reducing compliance risks, the Preflight Report helps anticipate claim approvals, enabling a quicker start on product fulfillment. This means faster delivery to patients and shorter time to revenue for DME providers. If errors are detected, the report helps you address them proactively, preventing deferrals and reducing denial rates.
Whether commercial, Medicare, or Medicaid – we can build the right criteria and requirements validation. Currently, our most common payors we support are Medicare, UHC, Aetna, Cigna, and Blue Cross Blue Shield.
Don't see your payor listed? No worries! We partner directly with our customers to build the payors most represented in their business.
PGS pricing is established on an individual customer basis involving several factors, including quantity of product categories, HCPCs, payors, and annual claim volume.
Schedule a consultation with a PGS expert to learn more about pricing and ROI.
PGS supports complex product lines including power and manual wheelchairs, CPAP, BiPAP, oxygen, bone stimulators, orthotics, walking aids, diabetic supplies, and more!
PGS is built with SOC II, Type II, and HIPAA-compliant security standards to make sure your data remains safe and protected. Want to know more? Ask us how we go above and beyond to protect your data!
