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All claims almost 97% are submitted to the payers within 24 hours of receipt acknowledgement, but the remaining 3% are batches received late and/or claims that need additional information from the clinic before being accurately submitted.
We deal almost all medical and non-medical specialties and our certified medical biller and coders are experts to manage practice professionally. Our specialties page will provide you details on the different specialties we serve.
We follow a comprehensive workflow through the patient appointment & scheduling system, EDI, Fax, emails, and FTP files. Our experts verify Primary and secondary coverage details including Patient ID, group ID, coverage period, co-pay, deductible and co-insurance information, and benefit information. We track information through best channel Calls, Web Portal system eligibility verification. We also get in touch patient in case of missing information. We verify a wide range of data and consist of detail summary report in excel format before two working days
Our Referral and Authorization verification process is varying according to provider Specialities. In a perfect world, we apply referral and authorization and prepare information according to practice unique requirements and save the money predictably, determine prior authorization requirements and prepare and submit paperwork to the payer through online web portal, faxes, phone lines and follow-up on submitted prior-authorization requests. We also track and notify the PCP and Specialist front desk staff for any issue with the authorization request
Every denial having unique description so our primary resource is special focus on each claim through systemically track, and analysis the claim history and get them resolve with best course of action. We design best intelligence reporting system, prioritize claims based on payer, amount, age of bill, or other business rules to ensure maximum benefits and prevent future denials.
It means that you are able to see patients and bill those insurance companies directly for the services you render.
It means insurance will no longer issue contracts for new providers due to a lack of network need, it has reached an adequate number of providers for a particular specialty and also depends on Area, state and county wise.
Credentialing is the process of verifying qualifications by which a healthcare organization assesses and confirms the qualifications of a practitioner. Privileging is the process of authorizing a licensed or certified healthcare practitioner’s specific scope of patient care services.
The six areas of general competency are
Privileging is the process of authorizing a specific scope of practice for patient care based on credentials and performance after executive committee in determining which privileges the applicant is qualified to obtain.
Accreditation ensures a meaningful fair credentialing process that protects both patients and providers from poor credentialing practices.
CAQH stands for Council of Affordable and Quality Healthcare. It is a nonprofit that was created several years ago by the private insurance panels. Most commercial payers require that one must have the CAQH profile completed before they begin the credentialing process. Panels use the CAQH to verify provider’s personal information as well as education and work history.