Solutions
Medical and Mental Health Billing Solutions
- Patient Registration: Collecting and verifying patient information.
- Insurance Verification: Confirming patient insurance coverage and benefits.
- Coding: Assigning appropriate medical codes (ICD-10, CPT) to diagnoses and procedures.
- Charge Entry: Entering charges for services rendered into the billing system.
- Claims Submission: Preparing and submitting claims to insurance companies.
- Payment Posting: Recording payments from insurance companies and patients.
- Denial Management: Identifying and resolving denied or rejected claims.
- Account Follow-Up: Following up on unpaid or underpaid claims.
- Patient Billing: Generating and sending patient statements for balances owed.
- Appeals Process: Filing appeals for denied claims.
- Collections: Managing overdue accounts and coordinating collections efforts.
- Reporting: Generating reports on billing and financial performance.
- Compliance Monitoring: Ensuring adherence to billing regulations and guidelines.
- Auditing: Conducting internal audits to identify and correct billing errors.
- Patient Communication: Handling patient inquiries and disputes regarding billing.
Admin - Insurance Credentialing & CAQH Solutions
- Application Preparation: Completing and submitting initial and re-credentialing applications for insurance panels.
- Documentation Collection: Gathering required documents, such as medical licenses, board certifications, DEA certificates, and malpractice insurance. -
- Primary Source Verification: Verifying the authenticity of provider credentials with issuing sources.
- CAQH Profile Maintenance: Keeping the CAQH profile updated with current and accurate information.
- Insurance Enrollment: Submitting and tracking applications to insurance companies for provider enrollment.
- Follow-Up: Monitoring the status of credentialing applications and following up with insurance companies as needed.
- Compliance Monitoring: Ensuring adherence to insurance company requirements and industry regulations.
- Ongoing Monitoring: Tracking expiration dates for licenses, certifications, and other credentials to ensure timely renewals.
- Re-Credentialing Management: Managing the re-credentialing process to maintain active status with insurance companies.
- Communication: Coordinating with providers to obtain additional information or documentation as required.
- Record Maintenance: Keeping accurate and up-to-date records of all credentialing activities.
- Reporting: Generating reports on the status and progress of insurance credentialing and CAQH monitoring.
- Policy Development: Developing and updating policies and procedures related to insurance credentialing and CAQH monitoring.