Eligibility Verification:
Before the billing process takes place the patient s insurance eligibility will be verified.
Electronic/paper claim submissions:
Most claims are submitted electronically. If required, we’ll send them on a UB04 or HCFA claim form.
Submission of Scrubbed and Clean Medical Claim to Insurance Payer
Secondary claims are submitted once the primary insurance responds.
Routine claim filing is done 5 days a week
All claims are filed to appropriate payers in a timely manner
Payer Payment Follow-up:
We follow-up with payers on all denied claims to determine the cause of the denial. When appropriate, we correct, appeal, and re-submit the claim. We always follow up to ensure timely payment.
Aged claim follow -up
Patient Payment Follow-up:
We generate patient statements and follow up on all unpaid balances. We process credit card payments and help establish payment plans if needed.
Charge Posting:
Review and track payments received from the payers for accuracy and appropriateness
Review and track payments received from the patients
Charge Entry:
Charge Entry from coded documents into Existing patient accounts. This includes billing information and denial details.
A Documentation trail will be made to individual accounts of the steps being taken to resolve accounts in a timely manner.
Once a patient’s eligibility is verified a new patient account is created.
System set-up:
We will make sure your medical billing practice system is set-up to ensure the billing process runs smoothly.
Credentialing:
We will handle your practice’s credentialing, whether it is initial credentialing or a re-credentialing application, we get the applications completed timely and accurately
We will make sure your Medicare application is current and properly assigned.
Will check Utah Medicaid’s PRISM site to be sure all information is up-dated and accurate.
Will maintain and up-date CAQH every 60 days when prompted.