Provider Services

Phase III – Collections.

Based on the analysis 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 parameters such as claims processing address and the other billing rules.

With Medicare claims, our team checks their status before submitting them to the carrier. Submission of duplicate claims becomes a compliance issue and so to avoid this, claims to the Federal carriers are checked before submission.

If the database has a large volume of non-Federal claims, it may not be possible to check the claims status of all the claims. In this case, our team will take a sample of claims outstanding to different carriers and check the status of the sample claims to generate a summary. Depending upon the volume of claims not found on the file in the carrier’s system, the team may find it advisable to submit all of the outstanding claims to the carrier to be processed.

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.

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.

After completing all the above and posting cash to the outstanding claims, patient bills are generated as per the client guidelines and then followed up with the patients for payments.