Submitting clean claims to insurance payers electronically (EDI) or on paper using standardized forms like the CMS-1500.

Review and appeal denied or underpaid claims.Identify and categorize denials, correct and rebill, communicate with provider, front desk, and coder, File an appeal if needed, educate and denial prevention.

Investigating and appealing denied or underpaid claims.

Work on current claims every week to prevent them from becoming old A/R.

Use providers' cloud-based PMS, EMR, ERA that supports claims submission, payment posting, denial management, records and reporting.

Ensuring all billing practices adhere to HIPAA regulations and other relevant healthcare laws. 

Recording payments received from insurance payers and patients.

Translating medical procedures and diagnoses into universal codes, such as CPT, HCPCS and ICD-10 codes.

Confirming and verifying patient demographic information and insurance details.Visit limits and prior authorization requirements.

Insurance verification is the process of confirming a person's insurance coverage is valid, active, deductibles, copays, coinsurance and meets necessary requirements.

Enrollment (or payer enrollment/contracting) is the subsequent process of registering the verified provider with specific insurance networks (Medicare, Medicaid, and commercial insurers like Aetna, Cigna, etc.) to establish a formal agreement for payment of services. EDI enrollment, ERA/EFT setup, and Clearinghouse configuration.

Recover unpaid claims, correct errors, resubmit, and appeal.

Reduce aging A/R, and Improve cash flow.

Credentialing is the process of verifying a provider's qualifications, including education, training, licenses, and certifications. CAQH setup,

Medicare/Medicaid enrollment, and commercial payer credentialing.

Provide mailing of patients' billing statement letters when needed by office practice.

Provide mailing of patients' appointment reminder cards when needed by office practice

Provide mailing of patients' collection letters when needed by office practice.