How it works

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Sign up – BAA & Billing AgreementWe sign business associate agreement adhering to HIPAA and Hitech Acts. Our billing agreement includes service level agreements, guaranteed productivity along with standard agreement clauses.
Provider Credentialing New practice or provider: We assist our clients to enroll in major payor networks. This ensures quick and optimal reimbursements for their services. Our dedicated credentialing experts ensure accurate and quick processing of credentialing forms by payor.
ERA / EFT EnrollmentsOur experienced staff perform this vital task of enrolling all our providers in Electronic Remittance Advice and Electronic Fund Transfer with all major payors. This process confirms quicker turn around on claims paid details and funds availability to our clients.
Eligibility and Benefits Verification Our eligibility and benefits verification services ensure that our physicians get paid for all the services they render. It also helps to efficiently collect the deductibles and co-pays upfront during patient’s visit to the provider’s office.
Pre-Authorization and Referral We verify authorization and referral requirements for all patients scheduled to our physicians. This eliminates possibility of payors denying claims for authorization/referrals and ensures clean claims.
Patient Registration / Patient Demographics All patients verified for Insurance eligibility, benefits, authorization and referral requirements are accurately entered in the EMR/Billing software. This process ensures claims are sent out with accurate patient and insurance information
Medical CodingOur certified coders and billers review Medical records / Superbills / Charge sheets to link the accurate diagnosis to each procedure code. Our experience in working on multispecialty ensures our accuracy levels. Our coders also provide suggestions to providers on documentation improvements.
Charge Entry / Charge CaptureOur billers capture provider information, date of services, date of admission or injury date, procedure codes with number of units, modifiers and diagnosis information on each claim. Our high accuracy levels ensure clean claims and quick reimbursements
Electronic Claims Submission All claims go through our claims scrubber process to ensure compliance on payor and CCI edits. Claims are submitted to Insurance companies by our clearing houses. Any EDI rejections received are worked on daily basis.
Electronic Remittance Advisory / Manual PostingOur professional payment posters loan and process the ERA files received into the billing system. Our manual posting team reviews low pays, no pays and denials. We accurately capture all denial codes along with co-pays, deductible and out of pocket expenses.
Denial ManagementOur revenue management experts analyze the denials in detail. They categorize the denials received and find solutions to fix and also to avoid future denials. This ensure all the claims are resolved quickly helping in quick turnaround of claim payments.
Accounts ReceivableThis is a critical process in overall Revenue Cycle Management. Outstanding AR is categorized by payor, aging and claim value. Our Bristol Byte workflow software makes it seamless for us to follow up and resolve claims quickly ensuring consistent cash flow for our clients.
Credit Balance Reporting / ResolutionCredit balance can be a result of double payment, overpayment and incorrect adjustments. Our Payment posting team ensures all credit balance are analyzed and resolved on time. This ensures on time refunds and correct balance billing to patients.