MEDICAL CLAIMS PROCESSING

By streamlining their medical claims procedures, our company has been assisting healthcare providers in increasing revenue. Our dedication to accuracy, efficiency, and flexibility—which we apply to the whole range of healthcare claims processing services—is what makes us strong. For the benefit of our clients, we have created a reliable model for handling claims processes. These models, which we have been refining over the course of our ten years of claims processing experience, give our clients the most effective manner to handle claims. Some of these models were developed using categories of denied claims by specialised teams tasked with tracking, comprehending, and pursuing denied claims.

 

Our Medical Claims Processing Services

Claims Audits & Support

We use a combination of highly skilled auditors and data processing systems for our auditing and medical claims assistance services. This is used by our clients to audit claims, analyse underpayments, identify practical recovery strategies, and post payments for all clean claims. To make sure that false claims don't enter the system, we undertake audits. Our audits of the processing of medical claims also assist in confirming that the provider is abiding by the most recent compliance rules governing medical claims.

Claim Setup

In order to create clean claims, our team of medical claims processing professionals in the USA makes sure that all patient demographic data is taken into account and precisely recorded. Any insurance-related data, including the payer or policy number, is gathered and entered into the programme. There are no doubts concerning medical necessity because each operation code is entered along with its matching diagnosis code. We make sure there are no mistakes during the procedure that could delay the claims processing.

Elegibility Verification

In order to create clean claims, our team of medical claims processing professionals in the USA makes sure that all patient demographic data is taken into account and precisely recorded. Any insurance-related data, including the payer or policy number, is gathered and entered into the programme. There are no doubts concerning medical necessity because each operation code is entered along with its matching diagnosis code. We make sure there are no mistakes during the procedure that could delay the claims processing.

Claims Adjudication

We have more than ten years of experience adjudicating cases manually and electronically. Over the years, we have helped more than 200 hospitals with a variety of medical claims management and claims adjudication needs, including provider information verification, eligibility verification, remittance processing, benefits determination, performing rule-based edits, insurance fraud detection, PPO repricing, etc.

Claim Document Imaging

Paper are converted into digital ones by our healthcare claims processing specialists. This makes it easier for you to organise and save all of your documents in a single, searchable database. Records are no longer missing or lost thanks to claims document imaging; instead, they are safely stored in a single digital repository. This results in more effective billing and record-keeping. Additionally, it enhances data security and guarantees HIPAA compliance.

Account Settlement

Our claim processing for healthcare services includes account settlement service. To settle the money owed to you, you must finish the necessary account settlement procedures and contact payment agencies and insurers. The service includes thorough knowledge of what the insurance covers and what you may legitimately claim, accurate documenting of your medical expenses and procedures, and prompt filing of claims. We follow up with the insurance companies and payment agencies after filing claims until the full settlement is reached.

We Achieve Medical Claims Processing Excellence by:

Give claims flaws, such missing data, coding mistakes, or previous authorisation, accelerated resolutions.

Manage all correspondence regarding claims to guarantee constant and strict follow-up with the payer.

Convert all papers to digital files so that it can be kept in a single, comprehensive, searchable database.

Real-time information that is in-depth for claims audits, decisions, and settlement payment amounts.

Manage rejected and denied claims effectively, make necessary corrections, and resubmit them for final decision and claims acceptance.

Why We are Supreme in Medical Claims Processing in Industry ?

Better Compliance

Rigid documentation standards to satisfy stringent HIPAA compliance needs and state-specific criteria for claims submission.

Great Automation

Support that saves time by automating the data entry of claims and ensures that clean claims are submitted on time

Strict claim audits

regular and thorough reviews of filed claims to identify the various types of submission errors

Extensive Training

Regular staff training to ensure full and up-to-date understanding of the policies followed by various payers to expedite the processing and settlement of claims.

Well defined Processess

Detailed examinations of representative samples are part of a well established quality checking procedure that makes sure that only the highest quality claims are presented.

Customised Analytics and Reporting

With built-in analytics views, real-time and continuous data is provided throughout the claims reimbursement cycle to track denials, payments, and any delays in final settlement.

The process We Follow for Medical Billing

  • 1. Data Entry

    Fill up the medical billing software with information about the patient's demographics, prescribing doctors, CPT and ICD codes, and modifiers.

  • 2. Correct Errors

    Check the documents for any billing mistakes and fix them if necessary.

  • 3. Adjudicate Claims

    Adjudicate healthcare claims for accuracy to get accuracy.

  • 4. Prepare EOBs

    Prepare an Explanation of Benefits (EOBs) containing details about claims.

  • 5. Claim Filing

    Submit and file the claim with the insurance company.

  • 6. Claim Follow-up

    Conduct follow-ups on the claims with the insurance company to get up-to-date.

  • 7. Resolve Denied Claims

    Process denied claims and resolve all error like coding, COB, Charges etc.

  • 8. Resubmit Corrected Claim

    Conduct final claims submission of corrected claim and again repeating the process to get maximum reimbursement.

Why Choose us ?

You can gain access to a number of advantages by outsourcing your medical claims processing to us. Among the main factors motivating you to select us are:

  • Reduce the amount of time it takes to file and process claims, and your revenue will rise by more than 20%.
  • Spend your money on BPO healthcare services, and let us handle the tiresome and boring work.
  • Take advantage of HIPAA-compliant services to ensure that all of your data is entirely secure.
  • Purchase services that are affordable and that will help you increase sales and decrease denials.
  • Hire a committed project manager to serve as your exclusive point of contact for all of your needs.
  • Reduce administrative overheads
  • Learn about powerful procedures that guarantee a high level of accuracy and improve your chances of recovering the claims.
  • Gain access to skilled workers without needing to hire more resources
  • Check for tiny bugs to improve your chances of having your claims accepted.
  • Utilise the most recent medical claims processing software to protect private patient information.
  • Receive periodic reports on the status of your claims and your ongoing projects.
  • Detect any duplicate claims
  • Get access to fully automated payment solutions
  • Minimize compliance issues
  • Increase Adjudication Rates