Billing and Credentialing Services
Services Offered
Full Charge Billing
Credentialing Services
Clearing House Services
Denial Management, Reimbursement, and benchmarking Services
Claims Management
Focus on all specialties for Physician Billing
Medical Billing Services
- Paper and electronic claim submissions for primary and secondary insurance
- Manage monthly patient statements, when insurance doesn't cover or patients' responsibility
- Payments and posting to patient accounts
- Handle all patient inquiries about their medical statement
- Research and appeal denied claims
- Post adjustments, payment entry, charge entry as needed for EOBs ERAs, etc.
- Maintaining accurate revenue from patient payments and insurance reimbursements
- Increase in collections
- Reduce denials
- Reduce bad debt
- Maintain and clean up AR daily to maximum reimbursement
Credentialing Services
- Processing initial credentialing and re-credentialing applications
- Screening practitioners' applications and supporting documentation to ascertain their eligibility Identifying discrepancies in information and conducting follow-ups
- Maintenance of internal and external databases (CAQH, PECOS, NPEES)
- Assisting customers with credentialing inquiries
- Responding to health plan providers inquiries
- Responsible for follow-up after submission to ensure that health plans appropriately processed the request, and that provider information shows correctly on the health plans website
- Audits Health Plan Directory CAQH creation and maintenance experience
- Medicare & Medicaid enrollment and revalidation
- Perform provider roster reconciliation
- Performs other duties as assigned