Aging and Due Process
Once submitted, In-Network (IN) claims can take 1 to 2 weeks to review, process, and pay, whereas Out-Of-Network (OON) claims can take 30 - 45 business days. If partially paid or rejected, claims may need additional work, which can result in further delays. Our case specialists follow up with each claim, making sure all claims are paid in full, otherwise we reprocess for additional reimbursement, until either the IN rate has been met, or the OON allowed amount has met the billed amount.
Not every insurance carrier accepts e-claims. Often, paper claims or paper appeals, are necessary to push the process forward. However, this process may result in long delays due to human error or lost paperwork. We have developed a process that ensures all claims and appeals are received and processed accordingly.
Paper Trails & Due Diligence
Especially when dealing with Out-Of-Network(OON) billing practices, such as Radiology,Anesthesiology,Pathology, and Laboratory, insurance carriers decide to mail the check to the patient, while making the patient responsible for the whole billing amount.
This process is meant to deter patients from seeing OON practitioners and specialists.
Our team works closely with patients, by phone, statements, personalized letter, and pre-paid envelopes which help reduce missing checks.
Patient Statements and Payments made to Patients
Often insurance carriers make payments to patients, especially when the service provider is non-participating.
Don’t worry! We have developed a successful and efficient process that combats these issues and deals with these problems proactively.
We handle all inquiries and requests directly over the phone. No delays, no wait times, no worries.
Our team is based in New York and we operate during normal business hours. However, we can provide your business with a phone line during non-business, and weekend hours.
We got you covered, from 6am to 11pm EST.
Patient and Insurance Carrier Inquiries
We pride ourselves in our reporting capabilities.
From simple A/R reports, to customized add-hoc reports, to reports that can effectively showcase and answer any questions about Payer Mix, Revenue Trends, CPT Reimbursement, Referring Provider Collections, or anything else that will help you identify sub-par revenue generating locations, we got you covered!