The Payers communicate with the service provider in the language of ‘Standardized Codes’ which explain the patient diagnosis and the treatments, services, or supplies the patient received.

Accurate and complete capture of the Standardized Codes (under CPT, ICD-10 and HCPCS) is necessary to get full reimbursement for your services rendered.

We help you in translating the available medical information into the right coded language for claim creation and submission with the payers, through a pragmatic process covering the following

• Obtaining medical records from your EHR / PMS via secured connection.
• Validating correctness of information
• Assigning CPT / ICD information
• Preparation of Coded Charts
• Performing an audit of the coded charts by the Quality Assurance team

Our claims submission team undertakes the necessary final checks to ensure resolution of any issues during the claim submission process.

These checks are performed at various stages and include

• Practice Management Systems – system functionality, accuracy.
• Bill Scrubber – automated and manual edits.
• Clearinghouse edits – completeness or correction of information.

Once the claim is submitted, it may rest with the Payer under ‘denied’ or ‘partially denied’ status. We do the necessary edits for claims refiling in close coordination with the Payer for maximized reimbursement for your practice.

Failure to collect reimbursement lengthens the Accounts Receivable (AR) cycle and increases the risk of revenue leakage. Our ‘Track-Trace-Act’ approach helps practices to expedite claim reimbursements and reduce the AR days.

Our core set of activities include

• Track – follow up with Payers through multiple channels to get an accurate status of the claim
• Trace – supply additional information or make corrections, wherever needed.
• Act – Refile the claim (including with secondary insurer) and initiate follow up action plan till the claim is resolved.