Outsourced Solutions

Proven Billing CEO Proud Facts Based on Tenure in Industry

Managed Billed Charges
Global Workforce
Satisfied Clients

We will manage for you.

  1. Billing And Collections
  2. Benefit Verifications
  3. Utilization Review Management
  1. Billing And Collections

Claim Generation
  • Coding for both professional and institutional providers i.e. HCFA-1500 and UB04 Forms
  • Superior internal controls and processes to eliminate errors in data entry
  • Customized claim scrubbing software that ensures the industry’s fastest turn-around time for generating clean claims
  • Front-end auditing to ensure only reimbursable claims are generated
  • Generation of claims for secondary and tertiary insurance carriers
Electronic Claim Submission
  • Clean claims submitted electronically to ensure the fastest possible payment turnaround time
  • Real-time claim submission payer acceptance confirmations
  • Immediate correction of all electronic claims rejected by clearinghouse and payers
Claims Management
  • All billed claims are called on a consistent set call cycle
  • Effective and aggressive denial management system to get denied claims resolved
  • Fee negotiations for the highest possible rate with 3rd party pricers utilized by commercial payers
  • Assistance and execution of Single-Case rate negotiations for the highest possible reimbursement on services rendered
  • Our staff strives to get claims processed for payment within a 30 day period
  1. Benefit Verifications

Accuracy
  • Proprietary process for accurate representation of each potential client’s benefits
  • Reliable reporting on patient responsibilities, pre-certification and policy limitations and/or exclusions
  • Redundant benefit verifications process to ensure maximum accuracy
  • Free comparative verification of benefits stated between the insurance representative on the phone and online resources
  • Reporting on usual and customary rates per plan to assist with anticipated reimbursements per client
Training
  • Training on how to interpret benefits effectively
  • Training for your admission staff on how to easily identify key benefit items to assist in admission decisions
Completion Time
  • 60 minutes or less completion time for each benefit verification
  1. Utilization Review Management

  • A highly credentialed staff that are trained to understand payer requirements for all types of authorizations
  • Maximized length of stay for each level of care you provide
  • Ensuring each authorization obtained is what your clients deserve and not what the insurance companies think they should get
  • Successful peer-to-peer reviews
  • Clinical chart reviews
  • Preparation of all levels of clinical appeals needed by payers