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Benefit and Eligibility verification |
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| • | Accurate and prompt verification of all scheduled appointments. | | • | Verification which covers the copy, deductibles and special billing rules for the encounter. | | • | A report sent to each practice by 8.00 am which lists out patients who have high deductibles, invalid coverage and high patient balances. | | • | Obtaining the authorization for Chemo treatments based on the regimen proposed. This is a great help for the practices, as the staff are then free to concentrate on the clinical side. |
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Charge Capture |
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| • | Complete charge information is captured within 24 to 48 hours and audited for compliance and accuracy. | | • | Continuous reconciliation of billed services with rendered. | | • | Exhaustive billing rules per account that enables the staff to be updated on the processing rules. | | • | Diligent follow up for all pended claims to ensure 100 % reconciliation with appointments. |
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Payment Posting |
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| • | Payments are diligently applied to the accounts and at the same time matched with the fee schedules. | | • | 100 % reconciliation of the posted amounts. | | • | List sent for all refund issues and excess payments. | | • | Low payments and denied line items are researched for further processing and action. |
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Claims transmission |
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| • | Claims transmitted directly to Carriers or through clearing houses. | | • | Claims audited for compliance and accuracy which helps in reducing rejections. | | • | Rejections fixed promptly ensuring faster payment of claims. | | • | Thorough audit of all transmissions to ensure they are successful. |
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Denial Management |
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| • | Correspondence and research of denied EOB's to validate the determination or else arrive at corrective measures. | | • | Research the denials and work with the client's office and the insurance company to fix the problems and to get paid. |
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Insurance follow up |
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| • | Using proprietary work flow tools, our well trained staff diligently follows up with the insurance companies, and takes pay or specific steps to get the claims paid and liquidated. | | • | High volumes of claims addressed on a daily basis. | | • | No claims left un-addressed after 60 days of submission. | | • | Clear reasons for claims outstanding on 90th day. |
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