Credentialing helps the doctors/practices interested in participating with various insurances specific to his county/city/state. It is the process of review and verification of the healthcare provider’s information.

Review and verification includes: current professional license(s), current Drug Enforcement Administration and Controlled Drug Substance Certificates, verification of education, post-graduate training, hospital staff privileges and levels of liability insurance. The process begins with requesting Credentialing Application Kits from all the commercial and government health Insurances.

After submitting the signed applications, we follow-up with the payers to retrieve the Provider ID# or Group ID# confirming that the provider is participating with the insurance. We also give bi-weekly status updates to the provider until an effective date of enrollment is determined so the provider can begin claim submission.

We have designed our A/R Follow-Up in such a way that it increases the Revenue Collection for Physician offices. This part comes into action once the Health Insurance Claims (Electronic/ Paper claims or Manual HCFA forms) are submitted to various Insurance companies. Depending on the transmission type and length of time since submission we begin our follow-up:

Electronic Claims: Follow-Up begins after 15 days of claim submission Paper/HCFA Claims: Follow-Up begins after 30 days of claim submission

There are two types of claims Follow-Up:
· No remark claims: Any claims in which absolutely no status is known for the claim.

· Last remark claims: Any claims which remain unpaid for various reasons. These claims are routinely followed up on a monthly basis. The reasons for rejections include:
– Authorization Issues
– Referral Issues
– Medical Necessity and Medical Records requests
– Non-Participation with Insurance Network
– Terminated Insurance
– Coordination of benefits
– Wrong Diagnosis
– Inclusive Procedures
– Partial Payments
– Out-of-network claim status and deductibles
– EDI Rejections
– Letter of Protection from Attorney cases
– No status and No claim on File
– Workers’ Compensation
– PIP cases

The Follow-Up process is divided into 3 methods:
· Online Claims Follow-Up – Using various Insurance company websites and internet payer portals we check on the status of outstanding claims.

· Automated Claims Follow-Up (IVR) – By calling Insurance companies directly an Interactive Voice response system will give the status of unpaid claims.

· Insurance Company Representative Call– If necessary, calling on telephone an Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either websites or Automated phone systems.

Once the Follow-Up process has begun Denied Insurance claims will require extra effort for resolution. Denials management is divided into two categories:

· Claim Correction and Resubmission: These are the claims which are corrected, modified, and resubmitted as a corrected claim to Insurance companies. For such claims every effort is made to resolve the denial to avoid billing the Patient.

· Patients’ responsibility: These are claims which cannot be further worked upon and the final bill is sent to the patient for payment collection. The reasons for sending the patient a bill generally include In-Network deductibles and non-covered benefits as per the insurance plan/policy. Patients will receive a statement with a clear explanation for the balance due.

Our Denial Management services helps resolve complex and time consuming payers issues. Our highly vigilant Denials team provides detailed analysis and insight into every single denied claim.

All denied claims are identified directly from the EOBs and duly tagged according to the reason for their denial. In essence all denials are extrapolated from the other outstanding claims in the system in order to take a directed approach in resolving them.

Denied claims is a major feedback mechanism and we proactively and cautiously study what can be corrected internally to prevent rather than correct such denials in future. Our quality assurance takes coherent steps to tune up future work-flow.

The other methodology is deployment of a dedicated Denials resolutions team. It is set aside to fix all denials and resend them prior to their timely filing limit. In addition all denied claims requiring telephone correspondence with patients are done with an evening customer service team. Proactive efforts are taken to resolve claim denials to prevent sending patient statements which are routinely ignored and/or discarded. We resubmit corrected claims, submit medical records to justify medical necessity and track outcomes of the denials.

The most important process post patient care is capturing patient data correctly so that a clean claim could be produced for billing.

Often services rendered by providers are complex in nature, payer compliance guidelines and billing rules are dynamic and documenting and billing correctly is a challenging task.

For Claim creation the process starts with Demographics entry and insurance verification. Either through scanning documents to our billing team or having it shipped in packages we collect all the information necessary to generate an encounter: demographics, insurance information, and icd/cpt codes.

Once the information is retrieved the claim can be created using two methods:
· Manual Claim entry: Claims are created directly into the PM system from a route slip or superbill. Before any claim is generated verification is done for patient’s insurance eligibility. At the time of icd/cpt entry various online tools will be used to insure correct coding is done with modifiers, units, and charges.

· Autogeneration: Claims are automatically created directly from the appointment scheduler. ICD/CPT codes, modifiers, and units are entered into individual patient appointments along with Demographic information and patient insurance details. If any copayments are posted into the appointment details they are directly transferred into the encounter. At the end of the autogeneration process auditing of the newly created claims can still be done before submission. Our skilled and swift staff ensure error free recognition of all parameters and produce correctly coded claims. Our Quality assurance team insists minimum keyboarding errors and we synchronize the correct coding requirements from the insurance companies.

Explanation of Benefits (EOB) payment posting is done as a service using two methods described below:

Manual Posting: EOBs are sent to the posting team by scanning them in at the doctor office level, shipping them in pre-paid envelopes, or having them picked up directly at the provider’s location. Once they are retrieved posting is done only after creating batches of payments in order to prevent the problems of over-posting and under-posting payments from the insurance companies. This batch system allows for proper accounting making sure that the money deposited into the doctors’ checking accounts matches our posting “penny to penny”.

Auto Posting: EOB payments come in the form of ERA (Electronic Remittance Advice) files which are downloaded directly into the provider’s Practice Management system. All posting is done directly in the system so the provider can audit at any time. When necessary secondary claim submission, patients statements submission, and denials tagging can all happen at the time of payment posting.

Any amounts due to the physician from uncollected deductibles, co-pays, and coinsurance are eventually noted on patient statements which could be promptly mailed out.

We offer medical records indexing services to Healthcare clients. We index various medical records to Electronic Medical Records(EMR) system. Indexing of medical records is an important function since it includes storage of data such as the patient’s demographic and treatment details together in one place, categorically and systematically. This helps physicians and other medical staff access all the information quickly and easily.

Documents scanned in at the doctor’s office are categorically filed into the patient charts as per the requirements of the clinic. Clinical Reports will be given a time and date stamp to allow for more organized indexing. Other types of images which can be filed include Insurance card scans, inbound faxes, and hand written medical notes.

We specialize in making Index of medical records such as medical charts, doctors notes, Insurance bills EOB, ERAS, Superbills, Attorney letters, consent letters, etc. pls check below:

It is mandatory to hold medical records for atleast seven years. Maintaining and collating hard copies require a lot of storage place and human efforts. Keeping at a single location is further time consuming and complex. Our indigenous IT solutions and medical terminology based skilled and efficient resources adept to the most complex office automation scenario, reducing your cost and highly improve the documents retrieval score.