Fast, Streamlined, Cost Effective
‘engage & forget’ medical billing, coding, revenue management and Practice Management Services…
Payment Posting and EDI Solutions
We check submitted claims on a daily basis and keep track of payments received and tally them with deposits in your account. We ensure that you have visibility into what’s paid and what’s pending at every point in the claim cycle:
- Retrieve ERAs – directly from clearinghouses and payer portals
- Verify remittance details against patient accounts for accuracy
- Automatic posting/allocation of funds to claims, reducing manual errors
- Manual posting for non-ERA
- Daily reconciliation with bank deposits; identify and work on discrepancies/over and under payment
Accounts Receivable Management
We categorize your unpaid claims and persistently follow-up on those past due. We handle payer as well as patient receivables. We have a 95% recovery rate:
- A/R threshold notification – when set AR threshold is breached
- Unpaid claims categorized – by value and ageing buckets (30-60-90 day past due)
- Regular insurance follow up — documented with payer rep name, promised timeline, etc.
- Reduce AR backlogs — take your AR backlog struggle away
- Answer patient calls – on billing and payment questions
- Bad debt recovery – partner with professional collection agency, offer payment plans, write off uncollectible
- 95%+ recovery rate – within weeks
Claim Denial Management
Our trained and dedicated denial management experts are skilled in state, federal, and commercial payer denials and have experience across vast numbers of diagnosis, procedures and specialties so that our denial response is prompt and effective in resubmission and payments by payers:
- Resolve soft, hard, clinical, and administrative denials
- Immediate Actions – understand reason, correct; provide supporting docs; resubmit claims; call and communicate with payers to expedite resolutions; escalate issues as needed.
- Preventive Actions – classify denials e.g., coding errors, medical necessity, eligibility problems, etc., make appropriate process changes for each, identify and correct root causes like lack of staff training.
- Predictive AI tools that nip potential denials in the bud
Credentialling and Payer Contracting
We keep you in network with payers and your contracts and credentials current, always…
- Collect provider details and key documents
- Prepare and submit applications – e.g., CAQH, PECOS, Medicaid/ Medicare, private payers
- Maintain credentialing on an ongoing basis – proactively monitor revalidation deadlines, update provider profile in payer portals, conduct credentialing audits
- Payer contract negotiation, monitoring and renegotiation
- Medicare revalidation support
Prior Authorizations and Patient Scheduling
Leave time consuming prior authorizations to us. Pre-emptive payer policy compliance is one of the pillars of how we drive more and faster revenue for you:
- 24/7 support
- Identify prior authorization need for services and procedures; stay up to date on payer policy
- Prepare and submit authorization request with clinical notes, lab results, accurate dx and procedure codes
- Manage denials and appeals
- Schedule patients – per provider and facility availability; double check insurance and other details
- Use your current our practice management system
Patient Billing and Related Services
We build and manage your entire patient billing operations – from co-pay at the time of service to after service payments and receivables:
- Issue itemized bill with clear insurance adjustment
- Send reminders and follow ups and offer flexible plans, if needed
- Offer multiple billing options (e.g., online portals, mailed statements, or mobile apps)
- Answer billing enquiries. Ensure compliance with billing regulations
- Reconcile payments made and keep patient accounts up to date