Credentialing

We have the credentialing expertise to get paperwork submitted to various carriers and get you approved. In the event of a closed panel, we will continue speak with the carriers and put you on a waiting list, if it exists.

Our ultimate goal is to get you connected to be a participating provider. Our staff are experts in dealing with many carriers and understanding the proper way to submit the necessary forms to get an approval

Scheduling and Confirmation

Our staff can pitch-in during an overflow and monitor your calls for scheduling, re-scheduling and cancellations. In addition, we can call patients to confirm appointments and capture insurance information.

Verification and Authorization of Benefits

Prior to the examination of the patient, our team can assure that the insurance benefits are available for the upcoming visit. We can determine the individual deductible, family deductible, amount of deductible still pending to be met, benefit limitations and provide this valuable information prior to the actual exam. How many days in advance should this be done is determined by the practice.

Billing:

Billing can be broken down into various parts. Our staff is ready to help you with all of your billing needs or any portion that requires attention.

Coding

We have coders with a minimum experience of 5 years. All coders are certified by AAPC or AHIMA and are ready to take on the challenge of providing your billers with accurate information. In addition to verification of benefits, accurate coding means one step closer to accurate payments..

Charge Entry

We will accept a multitude of ways to deliver your charge slips to us.
Handwritten or printed super bills containing patient demographics, insurance information, diagnosis codes, procedures codes and dates of service.
Pick up charges for the day from your EMR/EHR.
Use our mobile app to deliver your charges for the day.

Payment Posting

Whether you get ERAs or EOBs, our team will carefully sift through the payments accepting all properly paid claims and moving to the follow-up bucket all claims that need further attention.

Denials Management

We will use your clearinghouse portals or your in-house software to determine any claim that is denied or improperly paid. We will resubmit or appeal the payment decision as needed.

A/R Management and Follow-up

Based on your company policy we will follow-up on unpaid claims. We will take care of all necessary corrections, resubmissions and appeals. General recommendations for our standard follow-up are 30 to 45 days after the submission date.
We provide customized management reports, in detail and in summary, as required by the practice.
In many cases we use the software contracted by the practice which provides total transparency to you and your management team.

Partial Services

We don’t require that you outsource all processes within your organization. Give us the processes that you are behind in or give us the items you don’t have time to keep up with. For example, if you have a great billing team and just need help in A/R follow-up, we are there for you. Run an A/R report and see how old your claims are, then give us a call if you don’t see the light at the end of the tunnel.

QoS (Quality of Service)

We do more listening so that you get better results. Our goal is to listen to your issues, so that our team can come up with solutions to resolve them. The team assigned to you will be in touch with one or more points of contact in your locations on a regular basis. Initially, we will be in touch 1 to 2 times a week. Once the process is smooth this can be reduced to once every other week, then once a month.

We strive for a quality of services that is second to none. In keeping that in mind, our goal is to work closely with your in-house team. Your in-house team is crucial to the success of our collaboration. As time goes on, we become a blended extension as your ancillary staff.