Claims

The first step is always good eligibility so you can collect the right amount at the time of service and get a good authorization. See our eligibility service.

The next step to getting paid is a clean claim. To key to getting your full reimbursement from the carrier is a clean claim that follows the carriers rules.

A clean claim is a claim with no missing or incorrect information. This includes following carrier rules such as required PQRS codes. The rules vary from carrier to carrier. Some may require PQRS codes while others do not. Some require an authorization number while others will reject the claim unpaid if there IS an authorization. 

Good claim submission is knowing how to review claims BEFORE they are submitted to make sure they arrive as clean claims at the carrier and ready for the fastest and highest payment possible. 

This process must be done within the carrier’s timeframe for Timely Filing. Each carrier has their own limit from 30 days to 365 days. If a clean claim is not received within the Timely Filing limit it will rejected and not be paid. You can not bill the patient for not getting the claim to the carrier quickly enough.

We will review your encounters right in your own practice management software, make an adjustments required to the claims and submit them to the carrier. This can be by trigger electronic claims out of your software or by printing physical claim forms at out office to be mailed to the carrier.

But there is always more to the story, Claims Management.

• Clearing houses only job are to take your claims and move them to the carrier
• They do not handle rejections from the carriers
• The do not follow to make sure all claims are processed
• Did you know even electronic claims can get lost!

We manage your claims. We review the average time for payment from each carrier and track down any lagging claims. We rebill where required and assure payment is on the way.