ELECTRONIC CLAIMS PROCESSING

We expertly process all technical protocols and industry standards that need to be met for an insurance claim. Electronic claims are processed more quickly, resulting in faster payments. And a growing number of insurers require it.

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An electronic claim is a paperless client claim form generated by computer software that is transmitted electronically over telephone or computer connection to a health insurer or other third-party payer (payer) for processing and payment. Manual paper claims are time consuming, error-prone, and take longer to process since they are sent through the mail (postage!) and then need to be processed by a human.

 

We submit EDI (Electronic Data Interchange) claims for you, and they are tracked from start to finish via your portal. This includes robust analytics that are always available to you – all in one place. You'll save time and get paid faster from insurance companies, so you can avoid the costly delays and disruptions to your cash flow.

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We only bill professional claims – typically, our clients are outpatient mental health providers in an office setting. We do not bill institutional claims which include hospitals, Skilled Nursing Facilities (SNFs), ESRD providers, Home Health Agencies (HHAs), Hospice Organizations, Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services, Comprehensive Outpatient Rehabilitation Facilities (CORFs), Community Mental Health Centers (CMHCs), Critical Access Hospitals (CAHs), Federally Qualified Health Centers (FQHCs), Histocompatibility Laboratories, Indian Health Service (IHS) Facilities, Organ Procurement Organizations, Religious Non-Medical Health Care Institutions (RNHCIs), and Rural Health Clinics (RHCs).

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• Reduce the amount of time and resources practices devote to manual administrative functions

• Pre-audit claim fields automatically for potential errors before submission to a payer

• Identify claim issues and provide online claim resolution before processing by a payer

• Submit claims almost instantaneously to a payer

• Reduce postage, supplies and mailing expenditures

• Track a claim’s progress between intermediaries (e.g., a billing service or clearinghouse) and a payer through an electronic audit trail

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Our electronic claims result in higher reimbursement, compliance with payers, and management across the revenue cycle. Electronic claims submission helps practices reduce the administrative burden and expense generally associated with manual claims processing and submission.