The credentialing process can be complicated and time consuming. We are here to help. Our professional staff can handle every phase of the process from determining eligibility to making the application to its completion.

Our service includes provider enrollment at the group practice and individual practice level. We work with all specialties and assist with enrollment in all insurance networks (Medicare, Medicaid, and Commercial Insurance). Our credentialing solution fits any practice regardless of size or specialty.

Our credentialing & contracting services include:

• Provider enrollment services for physicians and healthcare entities (credentialing and contracting with health plans)
• Medicare provider enrollment and re-validation services
• Credentials verification for physicians and ancillary healthcare providers
• CAQH and NPI registration
• Managed care contracting

Our staff will work with any insurance company to get your practice providers enrolled with health plans and to maintain your providers credentialing files. The credentialing process varies by payer. The time period to obtain approval for participation in network and insurance plans is determined by each payer individually. We maintain a checklist and will routinely and consistently contact the payer to follow up on the status of pending applications. After submitting a complete application, we have no control or guarantee as to if/and/or when an applicant will be approved for participation. The approval for participation is determined solely at each payer’s discretion. Payers often change their guidelines and criteria without advance notice. We will notify you when we receive notification that the provider has been admitted for participation with the effective date. Some payers will backdate to the requested effective date while others will not. If the provider treats a patient insured by a payer or network before their participation effective date, the charges may be denied or paid at an out-of-network rate.

Medical Coding 

Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician's notes, laboratory and radiologic results, etc. Medical coding professionals help ensure the codes are applied correctly during the medical billing process, which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers.

Medical coding happens every time you see a healthcare provider. The healthcare provider reviews your complaint and medical history, makes an expert assessment of what’s wrong and how to treat you, and documents your visit. That documentation is not only the patient’s ongoing record, it’s how the healthcare provider gets paid.

Medical codes translate that documentation into standardized codes that tell payers the following:

• Patient's diagnosis
• Medical necessity for treatments, services, or supplies the patient received
• Treatments, services, and supplies provided to the patient
• Any unusual circumstances or medical condition that affected those treatments and services

Medical Billing

Medical Eligibility Verification

Medical Billing Process is captivating its role in the health companies and has different departments to deal with. But are you sure that the income you receive or the staff time you give to your patients are worth enough? This can be assured only when you have proper medical eligibility verification in you billing system.

The very major step practiced by the ones, practicing medical science, is the verification of the medical eligibility of the patients. Insurance companies on a timely occasion alter their policies and programs and it becomes vital to go through the Medical insurance or the health insurance of the patient whenever he comes for the visit. This verification doesn’t let you drown in claims rejections or denials, or the delay of revenue management cycle. We support your billing system keeping “Medical Eligibility Verification” as an important venture.

Our Verification Covers Following Process

· Receiving the patient data, details, history of payment and schedule; and to revise them in every appointment.

· Checking of Insurance facts and facets and revising it covering their primary and secondary payers through call. Having a word with their authorized online insurance entrances is required.

· If the eligibility is expired or there are issues regarding the policies, we contact the customer and sort the problem.

· Finally the Billing system is upgraded accordingly with the assertion of member ID, group ID, coverage period, co-pay, deductible and co-insurance information with other benefits.

Demographics / Entry

We know that every piece of information in the patient demographic form is extremely crucial. We understand that it is substantial that the information entered should be highly accurate, else it can impact medical practitioner’s revenue. A good medical billing and coding company needs to follow this in order to reduce the rate of rejections of the claims.

Our Demographic Charge entry covers following process:

1. Receipt of files

2. File Allocations

3. Entry of Patient Demographics

4. EOB Follow up

5. Denial Analysis

6. Client Feedback

Quality Review

We make sure there are no inconsistencies and give timely quality reports and analytics that help you understand the scope of improvement as we perform quality audit at every step of the process.  

Electronic Claims Submission / Rejections Resolutions

We make it easier for you to submit claims electronically that helps to improve cash flow and minimize administrative costs. We help you save your time and money by using electronics claims submission process which gives ample of benefits stated below:.

1. Reduce claim rejections and re submissions

2. Rapid notification of claim receipt, status and payments

3. Enhance your cash flow and accelerate payer responses

4. Save time to enhance revenue performance like ensuring correct payment

5. Automated error checking that results in fewer rejected claims

6. Reduced claims submissions costs

7. Deliver claims to the health insurers in minimal of time.

Payment Allocation

We helps medical practices improve productivity with great payment posting solutions. It helps to streamline and automate the payment process which is achieved by posting insurance payments automatically via ERA and insurance checks with EOB. So, whether you have thousands of EOB’s or lock boxes, we ensure that all the payments are posted on time.

Our payment allocation services is supreme because

· We post claims accurately that highlights overall billing efficiency and analyses reasons for low inflows

· Depending on rate and nature of denials we implement our denial management expertise to sort the problem and bring down the denials

· We have the domain expertise and experience to maintain the accuracy of information

· Easily read and analyze EOB where EOB consists of patient’s name, account numbers, service dates, billed amount or adjusted amount, denial information, etc.

· Use EOB proficiently to understand why a patient need to pay the balance in cases like uncovered insurance, deductibles and co-insurance.

We also post payments with ERA (Electronic remittance Advice) that helps to simplify reconciliation of patient accounts. It also helps to explain about the payment and adjudication of the medical claims. 

Denial Analysis & Resolutions

 We improve healthcare reimbursement by offering suitable denial analysis and resolutions. To improve healthcare profitability, denial analysis is an important component that helps to analyze ambiguous data so denials can be minimized. For this, root cause is defined for each problem.  

 Our denial analysis & resolutions services offer following benefits:

· Identify source and reason for each denial claim

· Detect denial trends and patterns and identify root cause of costly denials

· Include process reports to measure denied claims

· Seamless integration of software and efficient workflow to prevent future recurrence of denial

· Deal with denials within 72 hours of receipt

· Reduced cost to collect

· Enhance account collections and manage denials efficiently

· Reduces manual work and effort to check for denial errors

 Accounts Receivable follow-up

Revenue flow plays a critical role in growing the business, and that’s the reason many healthcare providers struggle with the challenges of implementing an effective account receivable process to collect the untapped dollars. We understand the pain of account receivable process and how much effort and time it requires. Therefore, our specialized account receivable team helps you save your valuable time, keeping your focus on patient care and building your core business. We are one of the best medical billing companies.

We ensure for:

· Increase in around 10% to 20% revenue

· Improve in cash Flow

· Reduce outstanding receivables

· Increased collection ratio.