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.
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.
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1. Preauthorization Verification and Eligibility
We will carefully examine the patient eligibility for adherence, medical support, and accuracy of supporting documentation.
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2. Claim Submission
Once the insurer accepts the given documentation, our skilled team will submit finished claims, and you will be informed.
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3. Claim Follow up
We will submit the payment copy into the patient account for further reconciliation after collecting the reimbursed payout.
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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.
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5. Claim Filing
Submit and file the claim with the insurance company.
Better Compliance
Great Automation
Strict claim audits
Extensive Training
Well defined Processess
Customised Analytics and Reporting
Create policies write-offs
Denial Management Expedite
Analytics-Based Inputs
File claims to secondary payers
Manage Knowledge
Dashboard
File claims to secondary payers
Create policies write-offs
Elite Support
Quality Code
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.