EncoderPro.com is a leading web-based medical coding software solution developed by Optum (formerly Optum360) designed to streamline medical coding processes, reduce research time, and minimize rejected claims. It is an essential tool for professional coders, billers, physicians, and clinical staff in ambulatory practices, hospitals, clinics, and insurance companies.
Key Features and Capabilities
The software provides real-time, detailed search capabilities across over 20 volumes of procedure, service/supply, and diagnosis reference material. Its core functionality is built around accuracy and compliance:
- Code Look-up & Search: Fast, detailed search for CPT®, ICD-10-CM/PCS, ICD-9-CM, and HCPCS Level II codes.
- CodeLogic™ Search Engine: A powerful proprietary search engine that allows users to search across all code sets simultaneously using keywords, acronyms, or even misspelled words.
- Compliance Editor/Claim Scrubbing: Automated edit review (including CCI and NCCI edits) to check for proper unbundling, correct modifiers, and complete diagnoses prior to claim submission.
- Medicare/Payer Content: Access to Medicare coverage instructions, medical necessity edits, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs).
- Automatic Updates: Real-time, automatic monthly code updates (Optum Edge) ensure compliance with the latest coding standards and regulations.
- Historical Content: Access to a 24-month historical content database (available in Expert/Payer versions) for use during claim adjudication.
- Add-on Modules: The platform is highly customizable with add-ons like the HCC Analyzer (for risk adjustment coding), E/M Code Evaluation Tool, and Clinical Documentation Improvement (CDI) content.
Target Users and Use Cases
EncoderPro.com is suitable for a wide range of healthcare organizations, from small ambulatory practices to large enterprises. Primary use cases include:
- Medical Coding and Reference: Finding and validating CPT, ICD, and HCPCS codes quickly and accurately.
- Claim Compliance and Scrubbing: Reviewing claims for coding errors and making necessary changes to streamline the submission process.
- Reimbursement Optimization: Utilizing Medicare and payer policy information to ensure medical necessity and proper reimbursement.
- Training and Education: Accessing exclusive educational opportunities, webinars, and earning CEUs (Continuing Education Units) through add-ons.