Credentialing​

This includes maintenance of paper and online applications with payers. Though we predominantly work with Non-Par providers it is still important to make sure enrollment is up to date with payers for quickest claim reimbursement.

Patient Verification Check

Obtaining and communicating real-time eligibility verification and important benefit information prior to the patient's appointment. We provider you with patient's up to date accumulated benefits as well as MRC rates for each individual plan.

Prior Authorizations / Pre- Determinations

Our insurance specialists call insurance companies and get authorizations in the most efficient manner. Our vast experience in the field helps us to review and gather evidence of medical necessity directly from our client's software to obtain prior approval. We will draft letter's of medical necessity to be reviewed and signed by physician on a case to case basis.  

Coding

 We have a team of certified coders to analyze and interpret medical records in their entirety to ensure accurate selection of diagnosis and procedures codes. The proper knowledge of medical coding and reimbursement methodologies enables providers to receive the correct and maximum reimbursements available. We assign the correct ICD-10, CPT, and/or HCPCS codes derived from the medical records and reports from your practice.

Electronic and Paper Claims Processing

Claims are sent electronically on a daily basis and paper claims are mailed weekly if need be. We process claims for all Commercial HMO and PPO payers as well as Medicare.and workers compensation. We scrub claims before they are submitted to ensure correct codes have been used, there are no data-entry mistakes, and identify any missing information to avoid costly delays, denials, and resubmissions. We excel in accurately coding and billing for professional fees, medical equipment and supplies. We keep current with insurance specifications and regulations and ensure the fees are kept at the maximum allowable reimbursement. We focus on procedure codes so claims are not suspended or rejected. Secondary Carrier claims are processed upon receipt of the primary carrier EOB making sure that you receive the maximum amount covered by the insurance companies and minimizing out-of pocket expenses to your patients.

Aggressive AR Follow Up, Insurance Collections, EOB Analysis and Payment Posting

Each EOB is audited for correct payment and/or benefits and credited appropriately directly in client's software. When necessary, we  immediately and aggressively take steps to reprocess and repair unpaid or reduced claims to ensure that you receive every possible penny. In addition to tracking claims and EOBs as part of our daily routine, we run monthly accounts receivable aging reports to ensure we are current and reduce your accounts receivable days outstanding, which means less of your money is tied up. 

 Remember, if you don't get paid, we don't get paid. It is to our mutual benefit to collect the full reimbursement for services rendered.