Complete or Partial Revenue Cycle Outsourcing

• Patient Registration – we review patient demographic and insurance information to assure all necessary information is complete and validate it directly with payers
• Benefit & Insurance Verification – our support team confirms patient has active insurance, the exact product and patient financial liability.
• Pre-certification/ pre-authorization – we validate that carriers have certified required care before it is performed; assurance that the correct pre-certification/authorization numbers are present for billing so that payment will be received timely.
• Charge Entry – we provide manual charge entry as well as validation of information into billing system of all patient demographics, insurance information, codes, locations, and other relevant data.
• EDI Claim Submission – our global teams help with enrollment, creation, submission and reconciliation of claims, working & tracking of rejections for clean resubmission
• ERA Payment Posting – this includes downloading, importing, posting and reconciling electronic payments; identification of enrollment opportunities
• Paper payment posting – we support manual posting of payments and denials from paper eobs, batching and reconciliation
• Correspondence – our team navigates through all provider correspondence, updating system and taking appropriate action
• Underpayment analysis – given access to payer contract information, the team can validate payments are accurate per contract and flag those that are paid inappropriately for further follow-up and additional payment as required.
• Insurance Accounts Receivable Follow-up – we confirm the status of submitted yet unpaid claims with all types of government, commercial and private insurance carriers. Our proprietary system assigns and prioritizes accounts to expedite and increase payment.
• Patient Accounts Receivable Follow-up – AR follow-up of all outstanding patient balances, implementation of budget plans, and generation of collection files as appropriate. This may include both outbound and inbound calls.
• Denial Management – our team provides systemic analysis of denials to both resolve them in a timely manner for quicker payment as well as for root cause analysis and reporting to help correct the problem. This ensures the denial from re-occurring.
• Refund and Credit Balance Management – we support reviewing and working credit balances and processing of refund requests as appropriate