Submission of Claim Services

We maintain a perfect blend of cognitive intelligence and high-end billing tools to execute the entire insurance billing process with 100% accuracy and acceleration. This ratio drives our end-to-end claims submission services to maximize reimbursements while taking administrative burdens from your shoulders. Here’s how we do it:

• Integrate the billing software with EDI, EHR, EMRs, and your practice management system (PMS), to minimize data entry issues and ensuring a smooth workflow for electronic claims processing and electronic payments for accelerated payment cycles.
• Verify patient demographic details (name, address, physician referral, medical history) and insurance information (coverage details, preauthorization requirements, effective dates, expiration dates, claims address), and other relevant details, before submitting the claims.
• Handle the process of obtaining prior authorization for procedures as required by certain insurance plans.
• Conduct real-time claims scrubbing to ensure the validity and accuracy of all procedural and diagnostic codes mentioned in the claims files before an electronic submission to the clearinghouse.
• Assign specialists with specific expertise in billing types, including value-based billing, telemedicine billing, capitation billing, and episode-of-care billing.
• Pay attention to the specificity of claims forms, such as using the CMS-1500 form to bill Medicare, Medicaid, and private insurance payers like Humana, Aetna, etc.
• Ensure accuracy of CPT codes, ICD-10 codes, HCPCS Level II codes, revenue codes, and modifiers to minimize claims denials or rejections.
• Dedicate a professional to overlook claims status inquiries. This person liaises between the payer and the healthcare company to follow up on the claims adjudication process. Identify and rectify any contractual adjustments mandated by the patient’s agreements with payers.
• Receive EOBs from payers furnishing comprehensive information of medical services covered and not covered by patient insurance. This document delineates service charges alongside coverage details.
• Resolve any disputes in claims submission and initiate an appeals process to ensure complete coverage for maximum reimbursement.
• Furnish clear and comprehensive reports delineating charges, authorized amounts, deductibles, copayments, and co-insurance for every patient. Notify patients about their payment responsibilities to prevent unpaid bills for our clients.
• Maintain accurate records of all transactions related to claims, including receipts, invoices, bills, and any other relevant documents.