ZyWin® Claim Management Techniques

ZyWin®'s accounting system operates in the background as claims are added or updated. The data is immediately analyzed and checked for completeness by rule-based algorithyms based on code table information.  Medical billing has come a long way!

Adjustments and reversing entries are calculated, confirmed and posted to accounts by the system, remarkably reducing complexity and increasing accuracy. 

During data entry, the User is notified of any inconsistencies before continuing to post transactions. Charge, payment and adjustment entries are immediately recorded and saved; no waiting until daily closing. The result is a comprehensive accounting system that ensures accurate patient accounts and provides a broad range of account management techniques and financial reports.

Service Oriented Accounting

ZyWin® uses Service Oriented Accounting, rather than Patient Balance Forward accounting. If not using the ZyWin Automated Posting System, the User simply posts payment information exactly as it appears on the EOB or bill stub. Simple screens and ease of movement through the billing system promotes accuracy and fast assessment of account status. The results: uncomplicated, concise input and output increasing staff and patient understanding and satisfaction. 


Keeping Accounts Receivable at a minimum depends on tracking and follow-up of account balances. ZyWin® helps staff identify and act on unpaid services with several tracking reports. Reports permit selection of many options to tailor the output to suit varied needs. ZyWin®'s aging reports are extremely effective at uncovering unpaid, lost or misfiled services. 

Today, it is common for a patient's insurance coverage to change. ZyWin® easily maintains the balance and responsible parties, as insurance information is stored with each claim. 

Encounter Form tracking enables management to automatically find and flag “No Shows” and find services performed but missed on data entry. 

ZyWin® tracks the approved and payment amounts received from each insurance company for each CPT code, by provider and location. This information is used to alert staff when payments are posted that differs from previous amounts. 

Once a service is entered, ZyWin® begins tracking to make sure that services rendered become services paid.

Claim Filing

Insurance claims can be submitted electronically or printed immediately on HCFA forms to a primary, secondary or any other insurance carrier during account posting. Alternately, insurance claims can be placed on hold or batched by insurance type and printed later. 

Other submission methods (such as telephone) can also be designated. 

The claim filing process is so fast that the daily task of sending claims is easily kept current. 

Electronic Data Interchange

Electronic Data Interchange (EDI) is a rapidly exploding technology. See ZyWin® EDI for the full story. 

Electroinic medical billing or Electronic Claim Submission (ECS) is a part of EDI, and is the primary focus of most offices. ZyWin® sends claims electronically to an expanding list of insurance carriers, with NO PER CLAIM CHARGES. Claims are usually processed within 24-48 hours of transmission and paid much sooner than paper claims. Medicare claims are automatically sent on to secondary MediGap and Crossover carriers for co-pay processing. 

ZyWin ECS is the claim processing choice for any practice. Staff time, claim errors and turnaround are greatly reduced, leading to faster reimbursement and lower cost.

A companion to ECS, ZyWin Automated Posting System is used to electronically retrieve and post explanation of benefits from insurance carriers. APS, a proven product since 1991, is used by over 90% of ZyWin® practices. APS produces efficiencies that easily justify the cost of the entire system. 

 Patient Billing

ZyWin® produces professional quality bills that are thorough, easy to read and understand. 

Patient bills and receipts can be printed on demand at checkout time. Patient Bills are generated weekly, monthly or even daily by the automatic billing cycle. Individual or standard messages, due dates, payment plans and finance charges can be attached. The straightforward format serves to reduce staff time answering questions and insures prompt payment.

Bills are printed on plain paper and are window envelope ready with all types of printers. Preprinted forms are not required. A laser printer is recommended for fast, quiet operation and creates the best visual impression. On Multi-user systems, bills may be printed while others are using the system. 

You can optionally have ExpressBill handle your patient billing with electronic statements. This involves creating a billing file and sending it to ExpressBill via their software or through the Internet. This service includes envelopes, printing, stuffing and mailing. The mailing is completed within 24 hours of receiving the file. Now your staff can concentrate on collecting money! Please contact us for the current fees.

Account Posting

Patient accounts and claims are quickly opened with minimal keystrokes. Each service is directly accessed by number or located by patient account display. Posting is fast and accurate with the help of stored default values to reduce entry time and errors. 

The User enters information as it appears - ZyWin® takes care of the rest. Contractual allowances and remaining balances are assigned to the responsible party automatically. The Transaction Journal invisibly records all transactions and posts to the proper ledger, including reversing entries. 

The ZyWin Automated Posting System (APS) can electronically receive EOB's from an increasing number of insurance carriers. Payments and adjustments are posted automatically, saving hundreds of employee hours per year.  It really takes the drudgery out of medical billing.

“Hot key” Patient Balance

One key displays a Patient Balance Summary for quick reference. When a patient phones with a billing question, press the hot key and the billing summary instantly appears. 

Callers are satisfied when their questions are answered at once; the staff can avoid taking messages and making callbacks, further improving efficiency and practice profitability. 

Insurance Sensitive

ZyWin® helps practices comply with CMS (formally HCFA) and insurance carrier regulations and billing requirements in several ways: flagging non-covered procedures and pre-authorization requirements; providing built-in forms for workmen’s compensation, auto accident and other special billing situations; automatically calculating post-op periods, co-pays and deductibles. 

Furthermore, Auditron responds quickly to embrace and support programs made available by insurance carriers, such as on-line referrals and claim inquiry products/services. 

Auditron takes pride in the ability to consistently release industry required changes to ZyWin® products BEFORE deadlines arrive! 


Reports are a principal tool in effectively managing a medical practice. Good reports provide performance information and insight into the mix of patients, services, insurance company reimbursement and cash flow. ZyWin® excels at quickly compiling a wide range of highly selectable reports. Answers are at your fingertips with well over 80 formats and a wide selection of parameters in each report. Click reports for an overview of the reporting system and SOME of the many reports included with ZyWin®. 

ZyWin® reports track account balances by age, provide accounts receivable reports by accounting period, compile managed care/insurance reimbursement profiles and provider productivity reports, all designed to help manage practice operations and provide planning information. 

Reports include: 
    · Transaction Journal with deposit reconciliation
    · Cash Journal
    · Accounts Receivable
    · End of Period Reports
    · Productivity by Provider(s), by Location(s), by User, by CPT Codes, by Insurance Company
    · ... and many, many more

As there are a multitude of combinations in the report system, it’s impossible to list all possible permutations. 

Top of Page

next page

ZyWin Home Page

© 2003 Auditron Electronics Corp – All rights reserved