Services

Eligibility Verification

Our medical billing insurance verification process allows you to review a patient’s payment history and learn the exact amount a patient owes in the form of Copays, Coinsurance, and Deductibles.

Demo / Charge Entry

Our medical billing specialists handle demographics & charge entry. Your medical practice staff can track when and where the claims go, including whether they are filed within 24 – 48 hours.

Primary & Secondary Claims Dispatch

We maintain a 98% clean claim standard. Trends and analysis are shared with you and the Coding and Claims entry teams during your Review meeting or at your request.

ERA / EOB Posting and Reconciliation

Payments received through ERA / EOB are posted on the system within 24 – 48 hours and the reports are reconciled on a daily basis. Denials are captured and moved to the Denial Analysis team.

• Two levels of quality audit to make sure the process is on par with international standards
• Trained staff who understand patient responsibility, such as secondary balance, etc.

RCM Denial and Appeals Management

We employ a meticulous system to avoid disruption in your medical billing workflow and revenue inflow. Claim Denials are analyzed carefully to determine the root cause for each problem. Denials are escalated to the Denial Analysis team to ensure that they are resolved and won’t recur in future. Denial analysis is shared with your practice once a week.

• We deal with Denials within 72 hours of receipt.
• We proactively handle Appeals.
• We detect any trends and track the percentage of denials daily.

Insurance A/R Follow-up

Our medical billing accounts receivable representatives have collected millions of untapped dollars upon taking over new projects. We contact and call the insurance companies directly for outstanding claims over 30 days. Details of the report are shared with your practice once per week or month.

Patient A/R Follow-up

Our medical billing representatives have the experience and communication skills to deal with the increasing demands of self-pay follow-up. We streamline the collections process by sending monthly statements to patients on time, helping them manage their payables balances. Quality-certified Customer Service personnel ensure diplomatic and effective handling of irate patients and skip tracing, thereby reducing bad debt write-offs.

Provider Credentialing

To ensure your profitability, we identify the top carriers for your center or group based on your location and the type of services provided, and initiate the contracting and credentialing process. Download a credentialing information sheet here.

For a limited time, get FREE provider credentialing with a new billing account. Contact us to learn more.

Contracting and Negotiating

Are you considering renegotiating your rates? We will work with the insurance network rep to initiate the process and review your existing fee schedule. If a new fee schedule is negotiated, your future claims can be processed at higher rates.

Coding

Our certified coders (CPC, COC, CIC, CPC-P, CPM, CPMA, CPCO, CPC-H, etc.) have expertise in specific medical specialties and ICD-10 coding. They assist in documenting with appropriate CPT and ICD codes and Modifiers, and also educate your practice about procedures that can be billed together along with a particular treatment or accompanying medical services. As the “rules experts,” our coders stay current with code updates, best practices, and trends to ensure compliance with the latest coding guidelines.

Insurance Authorization

Prior authorization (also known as pre-authorization) is the process of getting an agreement from the payer to cover specific services before the service is performed. Normally, a payer that authorizes a service prior to an encounter assigns an authorization number that you need to include on the claim when you submit it for payment. We handle this seamlessly, avoiding any hassle for your staff.

EMR Setup

Looking for an EMR? We can help you evaluate systems based on medical specialty, ease of use, pricing, and other requirements specific to your practice. Our support service includes coordination with your pre-existing vendor, if any, and the new company, to upload or migrate your data.

A/R Practice Analysis

Our Practice Analysis provides a breakdown of the charges, payments and adjustments for the CPT and HCPCS codes, a breakdown of the method of payments and adjustments, and a breakdown, by provider, of the total number of claims, charges, payments, and adjustments. You also see up-to-the-minute detailed or summarized aged receivables data for 100% visibility of uncollected claims.

Health Care Credit Card

To avoid unnecessary delays in receiving paper checks, we can help your practice get set up for a temporary virtual credit card provided by some insurance carriers through a 3rd party vendor.

Additionally, if your practice accepts Care Credit, which can be purchased by patients specifically for health-related out-of-pocket expenses, we can collect the card details from the patients for your staff to process patients’ balances. If you authorize our access to your card processing terminal, we can also handle the processing.

Workers Compensation Medical Billing

Workers comp claims are processed manually and sent by fax or mail, unlike most of the claims that are processed with minimal human intervention through EDI systems for commercial payers or medical payers. Workers comp claims are processed and paid only after the medical records are thoroughly reviewed and validated by the claim adjuster/case manager. Our Numina billing team specialists stay current with all workers compensation guidelines, send required additional information and medical records on time, and contact the claim adjuster frequently to ensure timely payment. We can also handle the billing for services unrelated to the case that you provide for the same patient.

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