Medical Billing
Accurate, timely claim submission is the foundation of a healthy revenue cycle. We review encounter data, apply the correct procedure and diagnosis codes, and submit clean claims to your payers, reducing rejections before they happen.
We work with a range of payers including Medicaid (including ProviderOne), Medicare, and commercial insurance plans. Every claim is reviewed for completeness before it goes out the door.
What's included
- Claim preparation and submission
- ICD-10 and CPT/HCPCS coding review
- Medicaid, Medicare, and commercial payers
- Electronic and paper claim support
Eligibility & Authorization Verification
Billing a service the payer won't cover is one of the most common, and avoidable, causes of claim denials. We verify patient and client eligibility before services are billed, and we obtain prior authorizations when required.
For Medicaid-covered services, we check active plan status in ProviderOne to confirm coverage is in place before claims are submitted.
What's included
- Insurance eligibility verification
- Prior authorization requests and tracking
- ProviderOne active plan checks (Medicaid)
- Authorization expiration monitoring
Denial Management & Appeals
A denied claim is not always a lost claim. When payers reject or deny a submission, we investigate the reason, correct the underlying issue, and file a formal appeal when warranted.
We track denial patterns over time so recurring issues can be fixed at the source, reducing future denials and protecting your revenue.
What's included
- Denial reason analysis and categorization
- Claim corrections and resubmissions
- Formal appeal preparation and filing
- Denial trend reporting
Accounts Receivable Follow-up
Outstanding balances left unattended become write-offs. We actively follow up on unpaid and underpaid claims, contacting payers to resolve delays and push payments through.
Our AR follow-up process keeps your aging report clean and makes sure the money owed to your practice or agency is actually collected.
What's included
- Payer follow-up on unpaid claims
- Aging report management
- Underpayment identification and resolution
- Write-off review and recommendations
Payment Posting
Accurate payment posting keeps your financial records reliable. We post payments from explanation of benefits (EOB) and electronic remittance advice (ERA) documents, reconcile payments against expected amounts, and flag discrepancies for follow-up.
This step is essential for keeping an accurate picture of what has been collected and what remains outstanding.
What's included
- EOB and ERA payment posting
- Payment reconciliation
- Discrepancy identification
- Adjustment and write-off posting
Reporting
You should always know where your revenue stands. We provide clear, regular reports that summarize billing activity, collections, outstanding AR, and denial rates, in plain language, not billing jargon.
Monthly reports give you a consistent view of your revenue cycle performance so you can make informed decisions about your practice or agency.
What's included
- Monthly billing and collections summary
- Accounts receivable aging report
- Denial rate tracking
- Custom reporting available on request
Not sure which services you need?
Start with a free billing review. We'll look at your current setup and tell you exactly where we can help.