1. Comprehensive Claims Management

• Claims Submission: We ensure that claims are submitted accurately and timely, minimizing errors that can cause delays in the payment process.
• Claim Tracking: We monitor all claims from submission to payment, ensuring timely resolution and quick identification of issues that could lead to denials.
• Electronic Claims Submission: Utilize our electronic claim submission process to speed up the approval and reimbursement timelines.

2. Denial Prevention and Resolution

• Real-Time Denial Tracking: We continuously track claims and identify potential denials in real time, preventing future rejections by addressing the root cause.
• Denial Analysis: Our team thoroughly analyzes the reasons for denials, identifying trends or recurring issues that need to be addressed to prevent future occurrences.
• Proactive Denial Prevention: We implement proactive measures, including staff training and system checks, to reduce the likelihood of denials occurring in the first place.

3. Denial Appeals

• Appeal Submission: For denied claims, we ensure that appeals are submitted on time, using thorough documentation and evidence to support the appeal.
• Comprehensive Documentation: We provide the necessary supporting documentation for appeals, including medical records, authorization forms, and relevant communications to ensure successful claim resolution.
• Appeal Strategy: We develop a tailored appeal strategy for each case, ensuring the best chance for approval on contested claims.

4. Root Cause Analysis and Long-Term Solutions

• Trend Identification: We analyze claim denials over time to identify recurring issues, whether they are caused by payer-specific requirements, coding errors, or internal process issues.
• Process Improvement: We work with your team to improve billing, coding, and administrative processes to reduce future claim denials and streamline your revenue cycle.
• Ongoing Education: Our experts provide ongoing training for your team on proper coding practices, documentation, and payer-specific rules to ensure that the claims process is as efficient as possible.

5. Multi-Payer Support

• Insurance Payer Relations: We manage claims and denials from a wide variety of insurance providers, including Medicare, Medicaid, and private insurers, ensuring full compliance with each payer's unique rules and requirements.
• Payer-Specific Guidance: Our experts offer advice on how to navigate the complexities of payer-specific documentation, rules, and reimbursement practices to avoid unnecessary claim rejections.

6. Payment Reconciliation and Reporting

• Payment Reconciliation: We reconcile payments to ensure that the amount received matches the amount expected and identify discrepancies for quick resolution.
• Financial Reporting: We provide regular reporting on claim statuses, denial rates, and resolution progress, helping you track the health of your revenue cycle.
• Aging Reports: Our reports include aging reports that highlight outstanding claims, allowing your team to follow up on overdue payments and improve cash flow.