ZyWin® Managed Care Control

Managed Care is dominating the medical industry. Tracking referrals, reporting encounters and documentation have become major issues for all practices. Until now, primary care and other capitated or “episode-of care” providers have been forced to do twice as much work to track and report capitated services. Specialists have had no efficient way for tracking referrals. Referral Management Database and Encounter Entry are ZyWin's solutions.

Major Features

Referral Management

ZyWin's tracking capabilities make organizing referral information effortless. Referral management includes the ability to input and track referral information for patient accounts and services. Utilizations and expirations based on time or visits can be easily tracked.

The referral information is integrated into the ZyWin Appointment Calendar and service entry.

Automatic Recognition and Importing

A manual referral tracking system cannot efficiently track referrals. These referrals are imperative to getting paid for the specialist. ZyWin' s computerized referral tracking makes the difference. For instance:

While adding a claim, the referral status pop-up information window appears. This window includes referral number, issue and expiration dates, number of visits issued/used, type and status. The User highlights the appropriate referral and confirms the entry. The referral is applied and the number of visits used is incremented. ZyWin imports the referral number into the claim for paper or electronic claim submission thus eliminating manual entry and data entry errors.

Measure this included feature against competitive systems; we're sure you'll not find this level of integration and ease of use!

Ease of Use

For Users already familiar with completing paper referrals, adding referrals into the ZyWin system is elementary. The referral entry screen was designed to mimic the typical managed care referral. Lookup features are available for fields requiring carrier-specific data input with allowances for several diagnoses and procedures for each referral. There is no practical limitation to the amount of referrals that may be entered for any patient. ZyWin makes living with managed care, manageable!

For the Specialist Office, it’s a snap to enter a referral received on paper and even easier when imported electronically.

Appointment Calendar Integration

How many times do patients call to make an appointment and want to know if they need a new referral? Or, would you like to know a referral is about to expire before scheduling an appointment? ZyWin automatically recognizes if the patient has referrals and reports referral status upon adding an appointment. If the patient has expired referrals, the system also notifies the User. Staff can then inform the patient that a new referral is required. If a referral is active, the system will report important information such as expiration date, visits remaining, and more.

Practices without ZyWin's referral tracking, are forced to manually search for referral information when a patient calls for an appointment - impossible if there are multiple offices! Utilizing ZyWin, the time spent making an appointment is drastically reduced which is beneficial to the patient, staff and practitioner alike!

Quick Referral Reference

An instant “Hot Key” will pull up the patient’s referral information from almost anywhere in ZyWin. This easy to use feature is another tremendous time saver.

When a patient calls to see if they are in need of a referral, the answer is one keystroke away! No more searching through the patient’s chart to find the most recent copy of their referrals! Practices with multiple office locations can centralize the collection and data entry of the referral information.

EDI Referrals

Referrals through EDI (Electronic Data Interchange) are available for many carriers including AETNA/US HEALTHCARE. Auditron is working closely with managed care carriers to implement these EDI and other options into the ZyWin Practice Management System.

The new systems will replace POS (Point of Service) systems currently in use by the carriers. The goal is to eliminate paper-based referrals. This will streamline the office process and reduce costs for all involved, including Primary Care and Specialists offices.


Through the ZyWin Reports module, Users can print a user-defined report based on referral information. For example, a report can be used to evaluate the number of visits per episode-of-care over a time period for a particular location. Or, maybe you would like a list of expiring referrals with visits left unused. A Primary Care Provider may like a report of the referrals issued to compare against the reports given by the managed care carrier. Perhaps the most commonly requested report lists the patients and number of referrals based on referring source (or referred-to). All of these are possible with this flexible report interface. Practices can track the number of referrals issued or received by date, by referring provider for specified carriers.

Selection criteria includes:
    ·   Insurance Carrier(s)
    ·   Provider(s)
    ·   Valid Referral “from” Date.
    ·   Referral Expiration Date.
    ·   Referral Type.
    ·   Number of Visits Remaining.
    ·   Referring Source.
    ·   Location.

Encounter Entry

One of the most time consuming tasks of the primary care or capitated practice is tracking the necessary managed care encounter visits. Practices are usually required to imprint the patients ID card on carbon copy forms, which must be manually filled out and mailed.

ZyWin has integrated the ability to enter and track managed care encounters, effortlessly. This necessary tool for primary and capitated providers is indispensable. Instead of time consuming paperwork, encounters may be entered into the system like “fee- for-service” claims. By acknowledging that the entry will be an encounter, the system automatically zero's out the fee amounts except for the patient’s co-payment, if any, and labels the service as an encounter.

The encounters may be printed on a standard CMS1500 form or HIPAA compliant EDI batches submitted to participating carriers thus eliminating the need for filling out carrier-issued encounter forms. Most all EDI encouters can be sent FREE of per claim fees.

But not every carrier is capitated!? No problem. Each practice can indicate which carriers are capitated. It even allows the User to enter ”fee-for-service” claims for these carriers when necessary, i.e.. Immunizations.

Patient receipts can be printed on the spot for co-payments and unlike manual encounters; providers have access to Managed Care Reports through ZyWin Reports module. These reports can help evaluate participation with managed care carriers, a valuable practice management function.

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