Claim Analysis

We want to reduce and minimize any problems that may arise with claims processing. Claim editing plays an important role in reimbursements. Claims should be coded properly according to industry standard coding guidelines. The clinical edits are maintained, monitored and regularly updated.

Each claim is analyzed and any errors in procedure, diagnosis and codes are identified and brought to your attention immediately.

Detailed Explanation of Claim Processing

Before claims are submitted we:

  • Check patient and subscriber information and determine if any information is missing. This includes but not limited to place of service, date(s) of service, missing or invalid diagnosis code(s) and patient demographics.

Once claims are submitted, we:

  • Follow up on status of payment within 30 days
  • Determine if claims are paid in full, denied or reduced as per fee schedule/ RVU’s (relative value units)
  • Detailed remittance explanation is provided
  • Charge entry or payer reimbursement errors can be identified early before they spiral out of control. Transparency and the ability to run any report 24 hours a day gives you a sense of control that you never had before. Adding to your team will enable you to have your finger on the pulse of your practice.