|Credentialing & Re Credentialing|| 1) Credentialing & re credentialing for all Insurances |
2) upadate every three months
|Eligibility|| 1) Check prior eligibility for all scheduled patients |
2) Upadate Demographics Detail for all patient.
3) Provide missing Demographic detail for patients.
|Gateway Rejection|| 1) Review the clearing house rejection log and resubmit. |
2) Inform Doctor office of any missing/required information.
|Charge Entry||Create the charges and submit them.|
|Payment Posting-ERA/EOB/EFT|| 1) Post ERAs.If it is auto post by doctor system than,we review all ERAs and post it. |
2) REceive scanned EOBs from doctor office and post it.
|Payment posting - patient checks / co-pays / Deductibles|| 1) office staff to send the copies of any payment received from patient in our office or our mail.also provide list of credit card transactions. |
2) Post the patient checks,Co-pay/Deductible.
|Secondary claim submission||send secondary claims once a month to respected client office.|
|A/R Rejection & follow up|| 1) Work on daily denials from ERAs & EOBs. |
2) work on 60,90,120 &180+ aging
3) send any appeal request if required
|Reporting|| 1) Send weekly or daily report to show the charges entered,payments received. |
2) Send Monthly A/R report.Mark the payments pending from insurance.
3) Daily Denial Report every Month.
|Prior Authorization||Take Prior Authorization for specific Medical Procedures,MRI,CT Scan or Diagnostic Radiology|
|Medical Home and Meaningful Use||Provide complete guidance for Medical home through NCQA.|
|Prescription Authorization||Take Authorization for specific Medical Procedures,MRI,CT Scan,Diagnostic Radiology, or therapy services.|
|Medical Records Management||Send or recieve Medical Records as per Doctor office requirement.|
|PQRS Reporting||We guide Doctor office for accurate PQRS reporting for incentive and help them from paying penalty.|