MEDICAL CLAIMS PROCESSING SERVICES

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.

Medication Therapy

The Medication Therapy Management Core Elements Service Model Version 2.01 includes this as one of its fundamental components. Our pharmacy business service specialists help our clients gather patient-related data in a methodical manner so that they can investigate and find the finest prescription therapy for their specific drug-related issues. In addition to gathering and analysing data, we also develop a practical, practical plan to address the medication-related issues for the patients of our customer.

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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.

  • 1. Preauthorization Verification and Eligibility

    We will carefully examine the patient eligibility for adherence, medical support, and accuracy of supporting documentation.

  • 2. Claim Submission

    Once the insurer accepts the given documentation, our skilled team will submit finished claims, and you will be informed.

  • 3. Claim Follow up

    We will submit the payment copy into the patient account for further reconciliation after collecting the reimbursed payout.

  • 4. Denail Management

    Within 24 hours, we will look into and address any issues with short payments, denied claims, and inaccurate payments reported by your team.

  • 5. Claim Filing

    Submit and file the claim with the insurance company.

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.

Create policies write-offs

We create clear policies for corrections and write-offs. This enables us to alert you to unusual contractual alterations that could have an effect on your revenue cycle.

Denial Management Expedite

We maintain a record of all refused claims and forward them right away to the denial management team for timely review and resubmission to payers.

Analytics-Based Inputs

In addition to non-covered services, denials, prior authorization, co-payment, deductible, and front office collections, we also offer input on overall revenue trends.

File claims to secondary payers

Our services assist you to identify and process claims with secondary payers and ensure you get paid for any remaining balances.

Manage Knowledge

All of your business process rules are stored in our practise management systems so that we can stay current with changes and help you stay current.

Dashboard

We give you access to dashboards that give you real-time information on the state of your cash flow and where adjustments are needed.

File claims to secondary payers

Our services assist you to identify and process claims with secondary payers and ensure you get paid for any remaining balances.

Create policies write-offs

We create clear policies for corrections and write-offs. This enables us to alert you to unusual contractual alterations that could have an effect on your revenue cycle.

Elite Support

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Quality Code

Combine blocks from a range of categories to build pages that are rich in visual style and interactivity.
  • 1. Pre-sales Requirements Analysis

    After getting the client's approval, we begin our approach by outlining the possible advantages of outsourcing and conducting an assessment of the current process architecture. At this point, we facilitate a study of the requirements that covers the procedures that must be supported, the kinds of files and formats that must be used, the reports that must be generated, the turnaround time, and the service levels.

  • 2. Receiving Client Files

    The client scans patient charts and other relevant documents, then uploads them to our secure FTP server.

  • 3. Downloading and Allocating Files

    The files are downloaded by our medical coding team, who then assigns them to the proper pre-coders and coders for processing.

  • 4. Pre-coding

    The Pre-coders gather important data after downloading the files assigned to them, like the name of the physician, the location of the service, price modifiers, etc.

  • 5. Coding

    Procedural and diagnostic coding are the two fundamental divisions of the coding process. Following the guidelines of the CPT Assistant, HCPCS Level II, ICD-10-CM, and LMRP, our Certified Coders (CPC) facilitate this process. The Coding team then assesses the documents to make sure the diagnosis matches the designated procedure code.

  • 6. Upload of Completed Files

    Files that have the coding work successfully finished are uploaded to our secure FTP site.

  • 7. Quality Evaluation

    The client receives the files that have been uploaded to our FTP site and assesses the accuracy and consistency of the data.

  • 8. Feedback from Client

    To guarantee that we provide dependable and accurate medical coding services, we assess the client's comments regarding data quality and permit the required changes and data quality refinements.

Medication Therapy Reviews

The Medication Therapy Management Core Elements Service Model Version 2.01 includes this as one of its fundamental components. Our pharmacy business service specialists help our clients gather patient-related data in a methodical manner so that they can investigate and find the finest prescription therapy for their specific drug-related issues. In addition to gathering and analysing data, we also develop a practical, practical plan to address the medication-related issues for the patients of our customer.

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