21+
Years of Service
500+
Practices Served
2.5 M+
Claims Processed
Reduce Denials and Maximize Reimbursement
We bring over two decades of experience and a dedicated team of professionals to provide advanced medical claims processing services. Let us help streamline your entire claims processing, ensuring efficiency, accuracy and regulatory compliance.
We have expertise in transforming the traditional claims processing into an optimized healthcare claims management system that promises timely collections and reduces the risk of delays or denials.
Our team of specialists and advanced technology have ensured a meticulous process in place with various checkpoints to manage and mitigate common reasons for denials such as improper coding, incorrect handling of documentation and late submissions.
This ensures streamlined claims management, faster reimbursements and better financial status. Transform your medical billing with modern claims processing from us, Outsource Strategies International!
Our Comprehensive Healthcare Insurance Claims Processing Services
Eligibility Verification
We scrutinize the patient’s coverage to avoid unnecessary claim denials.
Claims Data Entry
Our team enters relevant details required for a precise and smooth claim submission.
Claim Adjudication
We review every claim, validating the insurer’s payment responsibility so that correct payment is ensured for the services provided.
Payment Posting
We ensure hassle-free payment processing by efficiently handling the release of funds from the insurer.
Claim Document Imaging
We capture and convert all documentation into digitized data, enabling an efficient billing system.
Denial Management & Appeals
We provide comprehensive services to identify, address and appeal claim denials.
Benefits of Partnering with Us
Speed up reimbursements by promptly capturing discrepancies like incomplete data, coding errors and prior authorizations.
Digitize all documents to create a searchable, central data repository that will simplify the handling of paperwork.
Proactively manage claims-related correspondence, making sure to follow up with payers on a regular basis.
Handle denied and rejected claims with expertise, fixing any mistakes and resubmitting for final approval.
Get thorough, real-time reports on settlement payment amounts, adjudication, and claims audits.
Maintain a consolidated digital repository, keep meticulous notes of all interactions with payers, and make sure that any flaws in claims are resolved promptly.
Flexible and Affordable Pricing Plans
Full-Time Equivalent
In this model, services are billed based on the equivalent cost of a full-time employee (FTE) for a specified duration, usually monthly or annually.
Per Verification Billing
Like an FTE model, a person is dedicated to your practice. Perfect for a practice that is busy. They work as an extension to your business.
FTE/Per Verification Billing
This option is ideal for a practice that is unsure about their work requirements. This can have per request pricing for eligibility and other functions.
How Our Medical Claims Processing Works
1
Notifying
the Insurer
the Insurer
Claims
Adjudication
Adjudication
4
2
Information
Gathering
Gathering
Payment Posting & Reconciliation
5
3
Claims
Verification
Verification
Appeals
& Settlement
& Settlement
6
1
Notifying the Insurer
2
Information Gathering
3
Claims Verification
4
Claims Adjudication
5
Payment Posting & Reconciliation
6
Appeals & Settlement
Notifying the Insurer
We will furnish reimbursement claims to the insurance company, within thirty days of discharge.
Information Gathering
We collate and organize patient information and relevant medical records, ready for submission.
Claims Verification
Our team validates the claim for eligibility, accuracy and completeness, mitigating any risk for denials.
Claims Adjudication
We will work with you in reviewing the claim and ensuring every detail is aligned with the requisites.
Payment Posting & Reconciliation
After adjudication, we manage payment posting and make sure any unpaid claims are released promptly.
Appeals & Settlement
In case of a denial, our team will work to resolve the issues efficiently, setting up for a successful claim in the future.
FAQs
What is medical claims processing?
This is the process of handling healthcare claims with insurance companies to release payment for the services provided. It includes validating patient information, insurance claims and handling denials and/or any discrepancies.
How does medical claims processing services assist healthcare providers?
We help providers by centralizing their complicated claims processing system thereby reducing administrative burdens and ensuring quicker reimbursement. Our tried-and-tested process ensures better accuracy and compliance, which mitigates claim denials and maximizes overall revenue.
How long does the process take?
This depends on various factors, such as the complexity of the claim, completeness of the documentation and insurer payer policies. With proper adjudication and faster turnaround time, our claims generally get settled within 30 days of submission.
What are the types of claims you process?
We handle all types of claim processing, including outpatient, inpatient, dental, pharmacy, and specialized care claims. Our services cover a wide range of policies, including Medicare and private insurance plans.
Do you manage claim denials?
Yes, we provide comprehensive claim denial management services. We work with the healthcare provider to identify the reasons for claim denial, perform necessary corrections and submit appeals for claims to be resolved.