Eligibility and Benefits Verification

Eligibility and benefits verification is the process of confirming a patient’s insurance coverage and benefits to determine what services are covered and the patient’s financial responsibility. Medical Billing Wholesalers uses a combination of technology and manual processes to verify eligibility and benefits quickly and accurately. This helps to ensure that patients receive the care they need without worrying about unexpected costs.

Patient Registration Services

Patient registration is the first step in the patient journey and it is important to make a good first impression. SPECIALIZED BILLING offers a full suite of patient registration services, including patient data collection, insurance verification, and new patient onboarding. We use our expertise and technology to ensure that the patient registration process is efficient and accurate.

Medical Coding and Audit:

Proficiency in precise medical coding and conducting comprehensive audits is our forte. Our experienced team ensures adherence to industry standards, mitigating errors, and ensuring compliance with coding regulations. By meticulously auditing coding practices, we optimize revenue cycles and minimize billing errors.

Charge Entry:

Swift and accurate entry of charges is vital for optimizing revenue flow and maintaining financial records’ accuracy. Our dedicated team ensures the seamless integration of charges into systems, facilitating efficient financial management for healthcare entities.

Electronic and Paper Claims Submission:

With expertise in both electronic and paper-based claims submission, we offer comprehensive coverage across diverse platforms. Our adept handling ensures seamless transitions between submission methods, optimizing claim acceptance rates and reducing processing time.

Rejection Management

Claims rejections can be a major source of revenue loss for providers. SPECIALIZED BILLING offers a rejection management service that helps to identify and resolve denied claims. We work with our clients to improve their claims submission process and reduce the number of rejected claims.

Payment Posting

SPECIALIZED BILLING accurately posts payments received from insurance carriers, maintaining detailed patient financial records. Our team ensures that payments are accurately allocated to the corresponding patient accounts, providing a clear picture of financial performance.

Denial Management/Accounts Receivable Follow-Up:

Diligent management of denied claims and accounts receivable follow-up is crucial for optimizing revenue collection. We employ strategic follow-up processes, ensuring swift resolutions and minimal revenue loss due to claim denials.

Correspondence and Appeals:

Skillful management of correspondence and appeals is integral to our service. We handle communications promptly and effectively, advocating for clients’ interests while ensuring clarity and transparency in all interactions.

Patient Statement Generation:

Our precise patient statement generation processes ensure clear and accurate billing communications. By employing advanced systems, we streamline the generation of patient statements, enhancing transparency and understanding in billing practices.

Quality Control:

Rigorous implementation of quality control measures across our operations ensures high accuracy and compliance. We prioritize quality at every stage, safeguarding against errors and upholding industry standards.

Revenue Cycle Reporting:

Our comprehensive reporting mechanisms offer valuable insights into revenue cycle performance. These reports enable informed decision-making, identifying areas for improvement and optimizing revenue cycle strategies.

KPIs and Analytics:

Leveraging key performance indicators and robust analytics, we optimize revenue cycle management strategies. Our focus on data-driven insights aids in identifying trends, improving processes, and achieving operational excellence.

Provider Enrollment/Credentialing:

Proficient management of provider enrollment and credentialing processes ensures seamless integration within healthcare networks. We navigate the complexities of enrollment, facilitating smooth transitions and network access for healthcare providers.