+1 408-878-3114

Services

We specialize in end-to-end Revenue Cycle Management (Healthcare Ecosystem) Solutions. Billing needs for both professional and facility providers are catered to with quality of service being the focal point. We guarantee improved quality with significantly reduced cost and 100% compliance with the laws of the land

Maximum office productivity depends on efficient Patient Scheduling. We can schedule visits for patients, take care of Registration and other formalities at Patient Access for you.

Denials based on COB issues can affect reimbursement in the initial 90 days. We also verify patients' insurance and eligibility to reduce COB and coverage issues..

Our elite team of Certified Professional Coders implements the principles of Correct Coding Initiative and medical necessity parameters in accurately coding CPT-4 Procedure Codes and ICD-9 CM Diagnosis Codes to prevent Compliance Risks or Revenue Loss. We are well-equipped for smooth transition into ICD-10 CM Coding.

Patient demographics are duly verified thereby resulting in creation of accurate patient accounts, which ultimately benefits during Collections. All rendered services are captured accurately and efficiently and the Charge Description Master (CDM) is reviewed for correctness of Revenue Codes and CPT Codes for the services listed.

Our systems are designed to meet all requirements set by the latest HIPAA 5010 standards for electronic claims transmission & validation. Any electronic rejections encountered in the front end are addressed on a priority basis for minimizing denials and enabling accurate processing of the electronic claims.

Apart from manual payment posting we also specialize in electronic payment posting. Our Electronic Payment Posting methodologies and Regular Audits are instrumental in proper posting of payments by both insurances and patients with proper measures taken for excess payments and offsets.

Efficient rejection handling helps to identify any loop holes in the electronic billing system faster & enhances the effectiveness of electronic claims submission. We identify trends in billing leading to reduced denials and appeals are completed keeping a close eye on AR Outstanding Days for accelerated reimbursements.

Correspondence from insurances, guarantors, patients, legal representatives of patients, in-house attorneys and collection agencies are responded and processed for faster resolution of aged AR without compromising on the compliance requirements.

We house patients' accounts representatives with extensive experience and eloquence in communication skills to cater to the rising demands of Self Pay Follow Up. FDCPA and PTCT compliant training is imparted on our qualified Customer Service Personnel to help them deal with irate patients, skip tracing thereby reducing bad debt write-offs. We implement the use of Predictive Dialer for voice based services.

We offer tailored end-to-end services in Collections and customizable Collections Management Solutions. Our elite team of Collectors certified by ACA (The Association of Credit and Collection Professionals) work relentlessly on increasing collections from your debtors whilst strictly adhering to legal and regulatory parameters.

With the emergent prominence of Accountable Care Organizations (ACO) into the healthcare market space, we have expanded our horizons to cater to create customer value and empower innovation for health insurance intermediary services, claims management systems and customer service for an array of insurance types.

Mailroom Solutions

Paper claims are collected & segregated separately into States & providers group by the mailroom solutions team. The claims are then scanned & assigned to the claims processing team who adjudicate the claim for payments or denials.

Data Conversion

Electronic Claims (ANSI 837I & 837P) are received from professional and facility providers via their respective clearing houses and are scrubbed through Code, Clinical and Coverage edits to eliminate any incomplete or invalid claims out of the system, thereby eliminating the time invested into unprocessable claims adjudication. Clearing houses play a pivotal role in transmitting claim rejection or acceptance reports electronically to the Providers.

Claims Processing & Adjudication

We provide solutions for claims re-pricing & adjudication which includes members eligibility verification, provider contract verification required for claims processing, verification of codes to spot bundling issues & duplicate claims. We also audit claims to ensure adherence towards compliance.

Member Enrollment and Eligibility Services

We enroll new members, provide customer service where we do financial counseling to help members choose the right plan, we also provide services for screening & conversion of members from Medicare & Medicaid to Managed Care Plans.

Provider Enrollment

Our dedicated Provider Enrollment team takes care of all your credentialing needs. We help you enrol your Group with all the insurance companies along with your individual providers. To ensure smooth cash flow, we facilitate in setting up the Group EDI, EFT and ERA set up with the insurance & follow up until complete to ensure smooth cash flow. We specialize in PECOS (Internet-based Provider Enrollment, Chain & Ownership System) for Medicare enrollments which enhances the enrollment process. We keep track of trends and updates with all the payers to ensure that we are most current in submissions to carriers.

Recruitment consultancy

We work hand in hand with our clients to fulfill their requirements in Healthcare, & Pharmaceutical. We provide a wide spectrum of Human Resources Solutions to deliver people with Expertise, Integrity and Accountability. We deliver the best possible match for the client and candidates.