Outsource Medical Claims Processing Service

We bank on our experience to lend speed, accuracy and efficiency to your claims process





Medical Claims Processing - Streamlined for Quick Results

MedBillingExperts 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.

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We Help You Streamline Medical Claims Processing. Here's How

  • 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

Our Well-Defined Health Insurance Claims Process

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.

Patient Scheduling and Registration
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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.

Your Insurance Eligibility

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.

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AR Management

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.

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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.

insurance verification services
denial management services

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.

Our Specialties

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

Read Our Clients Latest Reviews

Kavitha CEO, CHPPS (CA)

We used MedBillingExperts’ medical claims processing services to reduce the time taken to get claims paid. Their understanding of the process helped us increase our revenue by 22%, in the first few months of our association. Today, we bank entirely on their services to process all claims"

James Godfrey CFO Chiropractic Practice (New Jersey)

"We were finding it very difficult to process denied claims because of which our revenue collection was taking a beating. MedBillingExperts helped us streamline all our denied claims and re-adjudicate them for claims submission. They fine-tuned our process to make it more responsive and time efficient."

Process denied claims and re-adjudicate them
for claims submission

Types of Medical Claims We Handle

Our comprehensive range of outsourced healthcare claims processing services cover nearly all domains of the medical field including:

  • Dental Claims
  • Insurance Claims
  • Pends/Correspondence
  • UB92/UB04
  • Miscellaneous (Non-standard/Complex)
  • Vision Forms
  • Enrolment Forms Processing (EFP)
  • HCFA1500/CMS150
Types of medical claims in USA

We can also handle the following

  • Pharmacy
  • ADA forms
  • Provider-defined "Superbills"
  • Network claim forms
  • Pricing sheets
  • Prescription receipts
  • Explanation of Benefits statements

Explore More Here About Medical Claims Process

RCM Solutions

Our Process

Complete Medical Claims Process Exposed

Explore our comprehensive medical claims process can help you from adjudicating claims for accuracy to final claim submission.

Cost Benefit Analysis of Outsourcing Your Medical Billing

Infographics

A Cost-Benefit Analysis of Outsourcing Your Medical Billing Services

Get a better understanding of the costs and benefits related to outsourcing your medical billing services to gain insight into how critical an investment it could be.

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7 Chief Benefits of Outsourcing Medical Billing Services

Blog

Medical Claims Process – It Pays to Have a Game Plan for Getting Reimbursement on Time

When it comes to injury-related claims, make sure to provide information regarding the cause of the injury. Provide details of the accident through accurate diagnosis coding.

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We helped a Medical Practice Optimize Their Medical Billing Process to Improve Bottom Line

Case Study

Clear Backlogs by Improving Medical Claims Processing Efficiency

Our customized solution, helped the client clear backlogs at a speed three times faster than the original pace.

Read Our Case Study

FAQ's on Medical Claims Processing

Medical claims processing services are any services that check medical bills or claims for adequate information, justification, and validation to reimburse the medical care cost to the healthcare provider. Healthcare claims processing services range from simple claims setup to claims adjudication, denial management, and claims settlement.

When you outsource your medical claims to third-party service providers like us, you benefit from guaranteed HIPAA compliance and improved cash flow. We ensure a larger percentage of your claims get paid out to you. You also benefit from reduced errors and faster turnaround time.

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The average amount of time it takes to send a claim will vary from healthcare provider to healthcare provider. However, most states require insurers to pay claims within 30 to 45 days.

Our fees depend on the services you require. To get some insight into the numbers involved, simply fill out a brief form on our website so that we can give you a price quote for our services.

Electronic claims are electronically submitted to a health insurance company, or payer, to reimburse the medical costs incurred in providing services to a patient. Once a claim, or medical bill, is created, it is sent off to a clearinghouse where it will be scrubbed for errors and formatted correctly according to the specifications of that specific insurance carrier. The claim is then sent to the carrier, where the claim is evaluated and an Explanation of Benefits (EOB) is created containing details of the amount paid to the healthcare provider, dates of service, charges and procedures, etc. Once an EOB is generated, the claim is paid via an electronic fund transfer.

It can take as little as 2 weeks for our experts to get started on your project requirements. In that time, our team will evaluate your current systems and infrastructure to determine how best to integrate our solutions into your existing processes.

You can get support in a whole range of areas from claims adjudication to denial management and account settlement. Our experts will take on any challenges you may be facing to deliver streamlined claims processing that is cost-effective, yet of the highest quality standards.

Payments are received anywhere from 30 to 45 days from the day that the claims were submitted to the carrier. The amount of time it takes will depend on the provider and health insurance carrier you are working with. The more accurate and error-free your submitted claims, the faster they will get paid.

Yes, you can send medical insurance claims electronically to secondary insurance carriers provided you are not duplicating the claim and that the secondary carrier actually covers the medical services you received.

We process medical claims for our many clients and ensure that you receive maximum reimbursements for every claim. We process claims such as claim adjudication, eligibility verification, claims auditing, account settlement, disbursement etc.

We are different from other clearing houses because we spend considerable time training our specialists in the most current regulations and industry guidelines so that we keep issues related to non-compliance out of the picture. We also provide a whole new level of revenue cycle management intelligence to our clients to keep them competitive at all times. Our services are highly scalable and we bank on a QA team to ensure all claims are processed accurately.

You can contact us either via email at info@medbillingexperts.com or call us at 1-866-344-1936 to speak to a representative.

FAQs on Revenue Cycle Management Services

97%

Clean Claims On First Submission

24/7

Support

100%

HIPAA Compliance

25%

Increase in Collections

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Our Software Expertise

Software Tools We Use for Medical Billing and Coding Solutions