We organize and manage patient medical records to support the billing process and ensure compliance with federal, state, and insurance regulations. This is a critical step in avoiding denials and maintaining proper records for audits.

Our team takes a proactive approach in reviewing the medical necessity of patient services based on clinical guidelines, which is essential for obtaining insurance authorizations. We assign a dedicated UR (Utilization Review) specialist to your facility who works on your behalf to secure both pre-authorizations and ongoing authorizations for services. This specialist will manage the submission of clinical documentation required by insurance companies, ensuring that authorizations are obtained efficiently and in a timely manner. By handling this process for you, we minimize the chances of service disruptions or denials, while also alleviating the administrative burden from your staff. This streamlined process helps ensure that services are approved in advance and that ongoing treatment is supported with the necessary documentation.

Before services are rendered, we confirm patients' insurance coverage and benefits. This ensures that there are no surprises regarding coverage limits, which helps minimize the risk of denials and unexpected financial liabilities.

Our team prepares and submits claims on your behalf, ensuring accuracy and adherence to payer guidelines for prompt and correct reimbursement. This includes ensuring all required codes and documentation are included with the submission.

We actively monitor submitted claims and address any discrepancies or delays that arise, ensuring that claims are processed and paid in a timely manner. Our goal is to maximize reimbursement while reducing payment delays.

Once payments are received from insurers or patients, we accurately apply them to your facility’s financial records. This ensures that your accounts are up-to-date and reflect the correct payments for services provided.

When necessary, we engage in negotiations with insurance companies to resolve disputes, improve contract terms, or secure better reimbursement rates. These efforts aim to enhance your revenue while maintaining good relationships with payers.

For denied or underpaid claims, we handle the entire appeals process, including submitting the necessary documentation to recover lost revenue. We ensure that all aspects of the claim are thoroughly reviewed to give you the best chance of a successful appeal.