Eligibility and Benefit Verification
Our experienced professionals in Eligibility and Benefits team will check the
patient’s demographics, insurance benefit details and plan limitations
before the patient is checked in for the treatment so that your office can
discuss a detailed treatment plan with the patient explaining his financial
responsibility upfront.
We will perform checks for current (same day), future appointments as well
as walk ins.
Procedure Coding and Claims/Pre-Determination Submission
Our coding associates will add the CDT codes for all the procedures
performed during the treatment.
Our billing team will verify the CDT codes, ensure that all relevant
documents (treatment notes, x-rays etc) for claim/pre-determination
submission are available and send the claims to the insurance on a daily
basis.
A/R follow up, EOB/Payment Entry and Fee Verification
Our A/R team will follow up on weekly basis with the insurance and enter
the payment information from the EOBs and archive the EOBs.
We will also verify that the insurance reimbursement is in accordance with
the contracted fee schedule.
Appeals, Claims Resubmission, Payment Adjustment and Adjudication
Our team will submit appeals and resubmit claims if necessary. We will also
respond to the payment adjustment requests made by the insurance.
We will also review the patient refund requests.
Fee Schedule Updating and Data Entry
Our A/R team will follow up on weekly basis with If you’d like us to enter and verify your patient charge fee schedules and
insurance contracted fee schedules into your practice management
system, we will be able to assist you.
Our team can also approach insurances to add patient charge fee
schedules for new plans as well as updates on insurance contracted fee
schedule in the beginning of every year.
Credentialing, Contracting and Insurance Fee Negotiation
Our credentialing team will be able to assist you in completing new provider applications,
correspondence and follow ups with the insurance and timely updates on participation status of your
providers with the insurance plans accepted by your office.
Since insurance contracts are important from legal standpoint, we can discuss inclusion/modification of
few important clauses including payment recoupment and locum tenen billing with the insurance.
We can also compare fee schedules based on payor type, region and existing contractual
arrangement and request insurance to provide better fees.