Medical Claims Processing

Medical Claims Processing – Streamlined for Quick Results Streamlined for Quick Results

  • Medi Billing Experts has been helping healthcare providers increase revenue by organizing their medical claims processes. Our strength lies in our commitment to accuracy, efficiency and flexibility, which we incorporate across the entire gamut of healthcare claims processing services
  • We have developed a robust model for managing claims operations for our clients. These models have evolved through our decade long experience in claims processing and offer our clients the most optimal way to process claims. Some of these models are based on categories of rejected claims, created by special teams assigned with the task of monitoring, understanding and pursuing rejected claims.

  • We also provide our clients with complete control over rejected claims. As one of the leading medical claims processing companies in the industry, our clients can check how the claim is progressing in real-time and analyze the efficiency of the various stages of the medical claims management process.

  • All these, together, make our medical claims processing services cost and time effective.

  • Provide expedited resolutions to claims deficiencies such as missing data, errors in coding or prior authorization
  • Manage all claims-related correspondence to ensure follow-up with the payer is frequent and rigorous
  • Convert all documents into digital files so that all paperwork can be stored in one large central, searchable data repository
  • Provide comprehensive reporting for claims audits, adjudication, and settlement payment amounts in real-time
  • Effectively manage rejected and denied claims, correct errors and resubmit them for final adjudication and claims approval

Data Entry

  • Record all relevant information, i.e. patient demographics, CPT codes, etc.

Correct Billing Errors

  • Scrutinize all documents for billing errors and resolve them

Adjudicate Claims for Accuracy

  • Authenticate the accuracy of every medical claim

Prepare Explanation of Benefits (EOB) Statement

  • Generate an EOB Containing important details about the claim

Claims Filing

  • File the claims with the insurance Company

Claims Follow-Up

  • Conduct rigorous claims follow-up with the insurance carrier

Claims Status Update

  • Inform client about the status of their claim

Evaluate and Resolve Denied Claims

  • Process denied claims and resolve all errors

Resubmit Corrected Claim

  • Conduct final claims submission of corrected claim

Medical Insurance Claims Processing Services We Specialize in Include

Insurance Claims Setup

  • Our team of medical claims processing experts’ in USA setup clean claims by ensuring all patient demographic information is accounted for and accurately recorded. Any information about their insurance, such as the insurance payer or policy number, is collected and entered into the software. Every procedure code is entered alongside its corresponding diagnosis code, which helps eliminate any questions about medical necessity as well. In the process, we ensure there are no errors that can slow down the claims process.

Insurance Eligibility Verification

  • With our medical claims processing services, we verify the insurance policy coverage to ensure it was in effect on the date of service. Besides, they help you procure prior authorization from the payer. We look into the greater details of policy to spot exclusions accurately. This prevents claims denials and keep appeals to a minimum. Our verification services ensure your cash inflow remains uninterrupted.

Claims Document Imaging

  • Our healthcare claims processing specialists convert paper documents into digital files. This helps you store all your paperwork in one large, central, searchable data repository. Through claims document imaging, records are no longer lost or misplaced, but are securely stored in one digital archive. This makes for more efficient recordkeeping and billing. It also improves information security and ensures HIPAA compliance.

Claims Adjudication

  • We have over 10 years of experience in both electronic and manual claims adjudication. Over the years we have assisted over 200 hospitals with a range of claims adjudication and medical claims management requirements such as verification of provider details, eligibility checking, remittance processing, determination of benefits, performing rule-based edits, insurance fraud detection, PPO repricing etc.

Claims Support & Auditing

  • Our auditing and medical claims support services are a blend of highly qualified auditors and data processing tools. Our clients leverage this to audit claim, conduct underpayment analysis, find effective solutions for recovery, and post payments for all clean claims. We conduct audits to ensure that no fraudulent claims sneak their way into the system. Our medical claims processing audits also helps to ensure that the provider is adhering to the latest compliance regulations governing medical claims.

Account Settlement

  • Account settlement service is part of our claims processing in healthcare services. It entails completing the account settlement formalities and getting in touch with payment agencies and insurers to settle the money owed to you. The service involves having complete understanding of what the policy covers and what is that you can actually claim, proper documentation related to your medical costs and procedures and file claims in a timely manner. After filing claims, we follow up with the payment agencies and insurers until the final settlement is made.

Why We Are Regarded as an Industry Authority in Claims Processing

Extensive Training

  • Regular staff training to ensure up-to-date and thorough knowledge of rules adopted by different payers to streamline claims processing and settlement

Rigorous Claims Audits

  • Frequent and detailed audits of submitted claims to analyze the different kind of errors made in submitting the claim

Well-Defined Processes

  • Highly developed quality checking process comprising of detailed reviews of representative samples to ensure that only the highest quality claims are submitted

Enhanced Compliance

  • Rigid documentation protocols to meet strict HIPAA compliance requirements and state-specific regulations on claims submission requirements

Customized Reporting And Analytics

  • Real-time and ongoing reporting throughout the claims reimbursement cycle with built-in analytics views to track denials, payments, and any delays in final settlement

Powerful Automation

  • Time-saving support by automating claims data entry and ensuring clean claims are submitted the first time around.