Our team of skilled professionals works to ensure all claims and patient balances are processed accurately and on time—all at a single, affordable rate. We pursue every unpaid claim because we know that every charge matters, no matter the amount. Below is a quick breakdown of how our process works:
Charge Team
This team begins by entering patient details from demographic forms, ensuring accuracy in diagnosis and CPT code alignment. Charges are created based on the billing rules specific to each carrier and location. Every charge entry is completed according to our agreement with the client.
Audit
All daily entries go through a second layer of review to confirm coding accuracy and compliance with billing guidelines. This quality control step ensures that only clean claims move forward in the process.
Claims Submission
Claims are prepared for submission either electronically or on paper. Electronic claims are monitored via clearinghouse reports within 24 to 48 hours, with any issues addressed immediately. Paper claims are printed, packaged with the necessary documents, and mailed out.
Carrier Adjudication
The insurance carrier’s review team evaluates each claim. Once reviewed, the claim is processed for payment, and both EFT and ERA are sent electronically to our system.
EOB/ERA Review
We actively monitor for any payment issues using our aging report. If errors or denials appear, we research the issue, make corrections, and resubmit the claims. When needed, we contact the payer directly or file an appeal for reconsideration.
Patient Billing
Once insurance payments are applied, patients are billed for any remaining responsibility, such as deductibles, co-pays, or non-covered services. If no payment is received after three statements, accounts are escalated for further follow-up.
