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Claims are then filed and this bunch of information are sent to the Transmission department. The transmission department prepares a list of claims that go out on paper or through electronic media. Once claims are transmitted electronically, confirmation reports are obtained which are filed after all verification processes. Paper claims are printed and attachments done, and if necessary, put into envelopes and sent to the US for postage and mailing. Transmission rejections are analyzed and appropriate corrective action is taken.
Charge Team
In this department, we have competent individuals who first enter the patient personal information from the demographic sheets. They then check for the relationship of the Diagnosis code and CPT. Then they creates a charge, according to the billing rules pertaining to the specific carriers and locations. All charges are accomplished within the agreed turn around time with the client, which is generally 24 hours.
Audit
The daily charge entry then needs to be audited to double check the accuracy of this entry, in other words, this is the check and balance to make certain the billing rule is being followed accurately. Also this department verifies the accuracy of the claims based on carrier requirements to be sure we have a clean claim.
Claims Transmission
Claims are then filed and this bunch of information are sent to the Transmission department. The transmission department prepares a list of claims that go out on paper or through electronic media. Once claims are transmitted electronically, confirmation reports are obtained which are filed after all verification processes. Paper claims are printed and attachments done, and if necessary, put into envelopes and sent to the US for postage and mailing. Transmission rejections are analyzed and appropriate corrective action is taken.
Carrier Adjudication
The carrier Utilization Review department would then review the claim. Once the review is completed, the claim would then be adjudicated and processed for payment. Then the check and Explanation of Benefits (EOB) is sent to the provider.
Cash Application
The Cash Applications team receives the cash files (Check copy & EOB) and applies the payments in the billing software against the appropriate patient account. During cash application, overpayments are immediately identified and necessary refund requests are generated for obtaining approvals. Also underpayments/denials are informed to the analysts.
Patient Billing
When our analyst team requests that the patient has to be billed for a deductible or for the balance, the charge team would proceed to do so.
Collections
We also provide comprehensive collections to ensure high reimbursements. Please read more about this at our collections page.
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