In our working values we consider the following steps :
1. Demographics Entry
- Documents are sorted patient wise before entering into system.
- Patient account numbering is done once after sorting is done. All the information related to patients are entered in the system.
- After entering the details of patients the log of total patients, entered patients details and pending details etc. are maintained.
2. Charge Entry
- When demographic entry is done then charge files are sorted according to date of services provided to patients.
- Once sorting is done, full details of services provided are entered in the systems .
- After entering the details, the files are given to Quality Audit for checkin if there is any incorrect details found, then charge department is informed.
- If all the detials entered are correct then claims are transmitted and charge completion details are sent to US office.
3. Claim Transmission
- When Quality check is done, a seperate list of electronic claims is maintained.
- After that the transmission process is followed to avoid rejection. The claims are transmitted electrinically through Different clearing houses.
- If transmission is successful, the log of patient''s claim, pending claim and total claims etc. is maintained. if there is any mistake in log then charges department is informed for corrections.
- When Tranmission is colmpleted a feedback is given to charges department.
4. Cash Posting
- After Transmission Checks and EOB (Explanation of Benifits) are arranged.
- The insurance name and total check values are cross verified to avoid any mistake. If any mistake is found in the data then a follow up is done with insurance.
- With all the correct deatils the cash posting is done and details log is updated.
5. Denial Management
- Our A\R and Denial Management Specialists receive extensive training in AR follow-up.
- Aggressive follow-up starts 21 days after claim submission.
- Our Specialists are chosen for their analytical skills and are provided with access to all the documentation required to make sure that the claim is paid on the first call.E.g. When the Insurance rep says that the claim lacks authorization number, our Specialists are taught to immediately retrieve the authorization number from our database and fax it while they are still on the call.
- Within 24 Hours on receipt of EOB Denied claims are worked on, rectified and resubmitted.
- EOB is posted on the same day and All Denials which require additional documentation, are sent to the Doctor''s office.
- We are well versed with using correct appeal procedures in knowing Healthcare Laws and we specialize in working on old Account Receivables.
We are always open for suggestions, because we believe there is always a room for improvement