THYNK has over 4 Million business rules logic (rule edits) to detect and report errors and gaps that may exist in the medical claim
based on the regulatory and payer rules, policies and circulars from major regional regulatory bodies such as:
– Corporate Council for Health Insurance (CHI)- KSA
– Department of Health (DoH)- Abu Dhabi
– Dubai Health Authority (DHA)- Dubai
– Riayati– Northern Emirates

The rules reviews are based on:
– Claim mandatory data elements. Forming the minimal required data set to perform a claim scrubbing rules edits validation.
– Claim optional data elements. To enhance the accuracy and comprehensiveness of rule edits validations.
– Members Insurance Details, such as patient policy particulars.
– Payer Contract and Pricing based rules.
– Patient Demographics, such as age, gender …etc.
– Patient claims/encounters history.

• Core Crosswalks:
– International Crosswalks (CPT-ICD10CM and ACHI/ICD10AM)
– Local Crosswalks Localized UAE and KSA market crosswalks – based on payers/regulator guidelines.

• Extended Crosswalks:
Offering a wider scope extending on core MNEC Crosswalks and will include the following:
– National Correct Coding Initiative Edits (NCCI)
– Medically Unlikely Edits (MUEs)
– Principle Diagnosis Selection (PDx)
– Etiology/Manifestation coding
– Drugs-ICD Crosswalks: Local market Rule Edits
– Gender-ICD Crosswalks. International reference
– Gender-CPT crosswalks: International reference
– Age-CPT crosswalks: International reference
– Maternity-CPT crosswalks: International reference
– Laboratory Panel Coding
– Infusion/injection Coding

Support for developing business custom rules content managed by a team of expert rule and market expert teams to support
your RCM automation and specific review and validation needs.

Provides a comprehensive and visualized dashboards as well as tabular representation to help discovering areas for improvements and make your team prepared to act proactively on RCM related issues.

Advanced Machine Learning (ML) models covering:
a. Historical claims denial and payment patterns and prediction of future denial risk.
b. Denials not covered by rules and propose suggested rules to cover denials risk.

THYNK provide an API and an integration engine that supports HL7 and Webservices capability to streamline the integration with current HIS solution.