Eligibility & Verification
Eligibility checking is the single most effective way of preventing insurance claim denials. Our team begins with retrieving a list of scheduled appointments and verifying insurance coverage for the patients via on call verification with insurance rep, online portals, benefit Fax & IVR. We promise all VOB verified with 100% accuracy avoiding any denials of claims. Once the verification is done the VOB’s are put directly into the appointment scheduler for the office staff’s notification.
Accounts Receivable Follow Up
Online Claims Follow-Up – Using various Insurance company websites and internet payer portals we check on the status of outstanding claims.
Automated Claims Follow-Up (IVR) – By calling Insurance companies directly an Interactive Voice response system will give the status of unpaid claims.
Insurance Company Representative – If necessary calling a “live” Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either websites or Automated phone systems.
Denials & Appeal Management
Our Denials and Appeals Management service is designed to increase Revenue Collection for Physician offices.
Payment Posting
Our Payment posting is done as a service using two methods described below:
- Manual Posting – EOBs are sent to the posting team by scanning them in at the doctor office level, shipping them in pre-paid envelopes, or having them picked up directly at the provider’s location. Once they are retrieved posting is done only after creating batches of payments. This batch system allows for proper accounting making sure that the money deposited into the doctors’ checking accounts matches our posting “penny to penny”.
- Auto Posting – EOB payments come in the form of ERA (Electronic Remittance Advice) files which are downloaded directly into the provider’s Practice Management system. All posting is done directly in the system so the provider can audit at any time.
Demographics & Claim Entry
Once the information is retrieved the claim can be created using two methods :
Auto generation: Claims are automatically created directly from the appointment scheduler. ICD/CPT codes, modifiers, and units are entered into individual patient appointments along with Demographic information and patient insurance details. If any copayments are posted into the appointment details they are directly transferred into the encounter. At the end of the auto generation process auditing of the newly created claims can still be done before submission.
Manual Claim entry: Claims are created directly into the PM system from a route slip or super bill. Before any claim is generated verification is done for patient’s insurance eligibility. At the time of ICD/CPT entry various online tools will be used to insure correct coding is done with modifiers, units, and charges.
Credentialing
The process begins with requesting Credentialing Application Kits from all the commercial and government health Insurances. After submitting the signed applications we follow-up with the payers to retrieve the Provider or Group ID # confirming that the doctor is participating with the insurance. We also give bi-weekly status updates to the provider until an effective date of enrollment is determined so the provider can begin claim submission.