After submitting claims to insurance electronically or paper mail we track the claim with insurance company to make sure provider claims has reached the payer timely and make sure it gets paid. We track it by calling insurance companies or checking on website, we categorize Account Receivable resolution in 3 Phases.
We run aging report within 20 days of electronic claim submission to and start the follow up process; we make sure each claim has reached the right payer. We also make sure insurance company do not deny the claim for any additional information, generally private insurance companies process the claim within this time frame.
If there is any denial or insurance company has denied the claim incorrectly, we try to resolve on the call itself and document that to follow up in next 15 days.
Experienced medical A/R analysts initiate this phase by identifying the various issues for claims that are marked as uncollectible or for claims where the carrier has not paid according to its contracted rate with providers.
The filing/appeal limits of the major carriers will be checked and also the "claims submission address" will be checked for the claims to reach the correct processing unit. The team also confirms that "clean claims" will be reimbursed as per the contracted fee schedule.
Based on the analysis and our team's findings, the claims that are identified to be within the filing limit of the carrier are re-filed after verifying all the necessary billing information is correct such as claims processing address and other medical billing rules.
Based on the analysis and our team's findings, the claims that are identified to be within the filing limit of the carrier are re-filed after verifying all the necessary billing information is correct such as claims processing address and other medical billing rules.
Claims that have exceeded the filing limit of the carrier as well as the claims that appear to be underpaid by the carrier are appealed with the necessary supporting documents. Appeal procedures vary widely depending on the plan, carrier and state. These procedures are collected and applied on claims that are being appealed.
We will transmit the claims electronically directly to the carriers wherever possible and for the other carriers, claims are forwarded through clearing houses and aggressively followed up with the carrier for confirmation.
The ultimate success of Cash Acceleration Program is dependent upon several factors:
Certainly the completeness and accuracy of the account data provided is important. Prohealth provides the protocols, expertise, and resources necessary to perform a comprehensive collection effort. However, the more successful programs also have received a high level of support and cooperation from the provider's office.
Payment Posting, Secondary & Patient Billing
Our Cash Post Solution gets all our client payments posted precisely and usually within 1 business day, we can get all payments posted in the billing system accurately using cost effective solutions.
Prohealth offers medical billing services, focusing on every aspect of the medical billing / patient cycle. We strive to achieve the best possible timely reimbursement for our clients, as the faster one can prepare a bill, the faster and clean the claims the sooner the reimbursement. With this in mind we work 24x7 and have dedicated billers and billing analysts to work while you sleep.
