Services
Claims Submission
Track Payments
Patient Statements
Eligibility Verification
Scheduler
Document Imaging and Storage
Accessibility to the
System
EMR
Data Backup
Claims Submission
We submit your medical claims within
two working days of receiving your charge form (Superbill).
We submit electronic claims to over 2,500 payers nationwide including Medicare,
Medicaid, BlueCross & BlueShield, as well as Commercial payers; for those
few payers that still do not accept electronic claims, we submit the claims on
paper. We use both
CMS 1500
(HCFA 1500), professional and
CMS 1450
(UB 92), institutional; forms to submit your claims to payers.
We check your claims against
LMRP (Local Medical Review
Policies) in order to make sure that procedures are justified by the diagnosis
included in the claims; we also add the required modifiers according with the
requirements of each payer. Claim errors can be significantly reduced by using
our system, they are checked for consistency before being saved including:
ICD9-CM codes,
CPT-4 codes, DOS,
POS and much more; they are later checked by the Clearinghouse for payer ID and
insurance ID formats and much more. As a result we achieve a very high
percentage of clean claims reaching more that 97% on average.
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Track Payments
We track all payments, from third
parties and patients, being able to provide you with accurate aging reports of
your account receivables. We understand that having an effective tracking
system is paramount in order to obtain acceptable collection rates.
Our tracking system get started
the day after the claims are submitted with the acceptance and exclusion
reports from the Clearinghouse, those claims that were excluded by the
Clearinghouse are fixed and resubmitted immediately. In the following days
(usually 2 or 3), with the acceptance reports from the payers, we continue
tracking the claims. For those claims that are rejected by the payers, we act
immediately by gathering the required information from the insured party or the
providers’ office. These reports may become very useful in order to proof timely
filing in an appeals process.
The next step in tracking claims
is once EOB (Explanation of Benefits) are received. We act immediately (within
the same day) on denied claims; either by fixing the problem, calling the payer
in case is their error, by calling the insured party if the issue is
eligibility, COB etc.. We keep track of the resolution of these issues using a
spreadsheet and are also documented in the billing software. The tracking
information is available for our customers to see and audit.
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Patient Statements
We print and send patients’ monthly
statements on your behalf with different customized messages depending on the
aging state of the account receivable, customized specifically for your practice.
These statements are professionally printed on a daily basis with a detachable
portion including the account information, the “Pay to” address, etc.; we also
include an envelope for the patient to mail the payment. We provide your
patients with a toll free number to for them to inquire about their statements.
Since our customers have access
to our billing service, at the patients’ registration, they can see if there is
an outstanding balance for that patient and collect it before the patient sees
the doctor. For delinquent accounts, we can work with your collection agency or
we can propose one to you.
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Eligibility Verification
We offer you an eligibility
verification tool that checks eligibility of the patients electronically with
one click of the mouse, covering must insurance companies in a central
location. The results of each verification are stored in the system for future
references.
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Scheduler
We offer you a professional Scheduler
included in ClaimGear for each one of the providers, resources and locations of
your practice. Insurance eligibility of the patient can be verified from the
scheduler’s window.
There are activity reports that
can be obtained from the scheduler in order to search for appointments per
provider and resources in different status like: scheduled, cancelled,
confirmed, checked in, in room, checked out and no
show.
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Document Imaging and
Storage
Our document and imaging feature lets you view scanned
documents and images (such as insurance cards, lab results, reports, EOBs and encounter forms) directly from the patient record,
even if they were scanned at another location. It also allows us to work closer with our customers, once
the original documents are scanned and uploaded into the system at our
customers’ site, we are able start working on them immediately, and these
documents are link to each patient’s record.
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Accessibility to the System
We provide you access to the
system for as many users as you need, the users do not need to be in one
location, all they need is a computer that meets the minimum requirements and
an internet connection to access the system. The user’s access could be
restricted according to the functions they perform and the information they
need to know from different sections of the system and several reports, it can
also be restricted by time of day and day of the week.
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EMR
The billing software can be dynamically interconnected with any
Electronic Medical Records system as long as the later
is HL7 compatible, some of those systems are
Practice Fusion, Physicians Back Office, Sevocity, Patient Now, and MediNotes.
The interconnection can be setup within ten days.
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Data Backup
The system’s information is
backed up several times a day in real time in a tier 1 datacenter facility; it
is also backed up once a day to a datacenter across the country for disaster
recovery purposes.
Some of our clients would like an
individual backup/snapshot of all of their data to be stored at their office.
This provides the customer with their own backup in addition to the backups
that are performed in real-time at the datacenter.
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