| Provider enrollment/Credentialing services |
Provider enrollment/Credentialing services
Credentialing is a process whereby hospitals, health insurance companies and health delivery systems evaluate physicians with whom they contract, to confirm that they are adequately trained, certified and / or licensed to provide care. This is a time consuming process even if all the details are filed correctly. We will help you get enrolled and credentialed with insurance companies, by eliminating errors and delays.
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| Patient Demographics Entry |
The patient's personal information such as his/her name, date of birth, address, phone number, guarantor name, employer details and insurance details (Primary, Secondary, Tertiary) will be registered in the software. The details are entered with high accuracy and low turn around time. You can also utilize our online appointment and registration services, which will help you to create a paperless medical office. |
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| Eligibility and verification |
Eligibility and verification
Using the patient demographic details, we obtain the insurance coverage / benefit information for the services to be provided. Doctor’s office can utilize the information, leading to increased upfront collections and considerable reduction in denials. Peace of mind to patient and doctor.
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| Authorization and pre-certification |
We will also help you to obtain authorization and pre-certification for certain medical procedures from the insurance company prior to the beginning of the proposed treatment. This service will reduce your processing time and avoid denials, leading to better relations with your patient.
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| Medical Coding |
Our coding team consists of certified coders with multi-specialty coding experience. You may send us superbills with diagnostic notes, with or without ICD and CPT codes. If codes are already provided on the superbill, they are validated by our coding team compulsorily to prevent any ‘up-coding’ or ‘down-coding’ and therefore, any denials. Once the medical language is translated into alphanumeric codes, our coders will cross check with the LCD/NCD/LMRP and other applicable governmental directives. The accuracy of our coding will help to minimize denials and hence increase revenues.
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| Charge entry and Claims submission |
Charge entry and claims submission can be done either electronically or via paper. All necessary fields are entered in the claim form electronically and checked for accuracy before the claims are sent to the insurance company for payment. In most cases, claims are sent electronically leading to increased payments and reducing the Account Receivables days. For the insurance companies that do not accept claims electronically, certified mailing services are used to minimize denials related to timely filing.
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| Payment posting |
Insurance payments are posted to patient accounts from the EOBs. All the payments received are posted within 24 hrs.
For payers who do not have Electronic Remittance (ERA), our team will manually post the insurance payments into the patients’ account matching the respective allowed amount for each charge. Cash posted is reconciled and secondary claims are processed. During payment posting if any denial is received, the details are documented and sent for analysis.
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| Denial management and follow-up (Account Receivables management) |
We utilize effective tools to enhance the revenues of a practice and reduce denials. The root causes of the denials are captured and solutions are provided to prevent similar denials. We identify opportunities to collaborate with payers to avoid denied claims. We work along with the physician’s office staff to eliminate denials, leading to increased cash flow and revenue. All unpaid, denied and under paid accounts are analyzed, then follow-up is done with the insurance companies for account receivables. The primary focus is to reduce the AR days to the minimum. Extensive tracking tools and methods are utilized to achieve maximum benefits for the service provider.
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