Pre Visit
Transforming healthcare operations with our services
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Demographic Entry
Collection of patient information and consent required for the medical record in order to meet established clinical, financial and regulatory demands.
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Eligibility Verification
Validating patient’s eligibility and benefits to ensure provider receives payment for services rendered.
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Prior Authorization
Procedure of obtaining prior approval from the payer(insurance company) before the healthcare provider offers services to the patient.
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Medical Coding
Identification of medical diagnoses and procedures and documenting them in a patient’s medical record as universally accepted codes.
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Billing and Charge Posting
Recording information about the services provided into a medical claim for billing.
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Claim Management
Determines the amount of reimbursement that the healthcare provider will receive after the insurance company clears the dues.
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Utilization Management
UM is a process that evaluates the efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities provided to patients on a case-by-case basis.
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CDI/Chart Prep
Ensuring that the events of the patient encounter are captured accurately, and the electronic health records properly reflects the services that were provided.
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Credentialing
Credentialing process validates that a physician meets standards for delivering clinical care wherein the insurance verifies physician's education, affiliations, licenses, certifications, training, malpractice and any adverse clinical occurrences.
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Referral Management
Referral is the process of sending a patient to another practitioner (ex. specialist) for consultation or a health care service that the referring source believes is necessary but is not prepared or qualified to provide.
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Quality (HEDIS)
HEDIS® is a set of standardized performance measures developed by the NCQA to objectively measure, report, and compare quality across health plans.
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Payment/ ERA posting
Reconciling the payments received from the insurance payer to each individual claim. Once payments are posted, any secondary claims can be created and submitted.
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Denial/ AR Management
Tracking and managing unpaid claims ensuring that no time is lost on pursuing every reimbursement possibility.
