Referrals, Eligibility and Pre-Certification

An efficient revenue cycle management begins with the implementation of best process practices. We believe in proactive measures and clearly understand reacting on claims denied after 15-30 days of submission does not help the cash flow of our clients.  Our Eligibility Verification and Pre-Certification services eliminate claims being denied for “Non-Covered services”, “No Coverage at the time of services”, “Procedure requires referral or authorization” and more. Many denials can be eliminated by proper coverage verification and by obtaining referral/authorization prior to providing the services.

Verification process not only reduces denials on services performed but also increases collections by helping us determine the exact co-pay, deductible and out of pocket expenses. This helps us to make up front collections from patients during their visit.  Our verification specialists use various tools and software to get the job done. We access payer portals, EVRs to get the required information. We also make calls to the insurances and verify specific specialty based information.

Our pre-certification team ensures you have authorization from the patient’s insured for the services you have scheduled to perform. Insurance policies and coverage terms differ from patient to patient and our services help you to stay on top of all these issues.  Our reports are very specific to each client making it easy for your office staff to process. Our services help you to recover quicker reimbursements and maintain a healthy cash flow.

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