Since the implementation of the HIPAA law, providers are now required to submit most of their claims electronically. Most current practice management software packages will have some type of relationship with a clearinghouse that gives the provider the option of submitting claims electronically through that clearinghouse. However, understanding how to do this is not always as simple as it seems.
Most software packages are developed with the idea of appealing to a large customer base, and subsequently, they include more “bells and whistles” that go outside the scope of what a particular provider actually needs. While on the surface it seems that this added functionality might be a good thing, it actually creates more confusion for providers… who only want to focus on treating their patients, instead of spending their weekends reading technical software manuals on how to get their claims submitted.
Also, there are many providers who only see a small number of patients each month, and their total claim volume does not justify an investment in an expensive PM software package. These providers handle most billing related functions within their practice, and only need help with submitting their claims…that’s it.
It’s because of these, and other related reasons; that many providers choose to outsource their claims submission process to a billing service like us. We can help the provider streamline their billing process to make things more efficient, and subsequently increase the cash flow of their business. By outsourcing to a third-party entity, a provider can now focus on treating their patients without worrying about whether or not they’re going to get paid.
We will perform the following tasks below under our claims submission service:
- Enter all new patients, new insurance companies and all claim data into our web-based billing software. (It does not matter which state the provider resides. We can submit claims for providers from any state.)
- Submit all claims electronically through our clearinghouse.
(Both HCFA and UB claims.)
(99% acceptance rate when submitting electronically.)
- Verify that all claims were accepted into the payer’s system.
(If any claims rejected a payer’s edits, we will either fix the issue ourselves or notify the provider of the error message, and indicate what feedback is required.)
- Send claim batch reports to the provider after each submission.
- Submit secondary and/or tertiary claims.
- Notify the provider of changes in the healthcare industry that could affect how they submit their claims in the future. (Ex: ICD-10 Transition, etc.)
To summarize: The goal of our claims submission service is to expedite and maintain a consistent reimbursement cycle for the provider by submitting their claims electronically and confirming receipt by the patient’s insurance company.