Collection of patient information and consent required for the medical record in order to meet established clinical, financial and regulatory demands.
Read MoreProcedure of obtaining prior approval from the payer(insurance company) before the healthcare provider offers services to the patient.
Read MoreValidating patient’s eligibility and benefits to ensure provider receives payment for services rendered.
Read MoreIdentification of medical diagnoses and procedures and documenting them in a patient’s medical record as universally accepted codes.
Read MoreRecording information about the services provided into a medical claim for billing.
Read MoreDetermines the amount of reimbursement that the healthcare provider will receive after the insurance company clears the dues.
Read MoreUM 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.
Read MoreEnsuring that the events of the patient encounter are captured accurately, and the electronic health records properly reflects the services that were provided.
Read MoreCredentialing 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.
Read MoreReferral 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.
Read MoreHEDIS® is a set of standardized performance measures developed by the NCQA to objectively measure, report, and compare quality across health plans.
Read MoreReconciling the payments received from the insurance payer to each individual claim. Once payments are posted, any secondary claims can be created and submitted.
Read MoreTracking and managing unpaid claims ensuring that no time is lost on pursuing every reimbursement possibility.
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