Provider Services

Phase II – Analysis & Prioritizing.

Experienced analysts initiate this phase by identifying the various issues for claims that are marked as uncollectibles or for claims where the carrier has under paid and appropriate actions should be initiated to pursue the remaining valance.

Provider verification is handled by the call center to the major insurance carriers to identify and validate the Tax ID number, Pin numbers, and Group numbers for the providers.

The filing/appeal limits of the major carriers will be checked and also the “claims submission address” will be checked for the claims to reach the correct processing unit. The team also confirms that “clean claims” will be reimbursed as per the contracted time.

These verifications are performed on claims that are reimbursed Fee for Service and also for case rate billing. If the claims are capitated, adjustments will be taken as appropriate so that they do not falsely inflate the receivable amounts on the books.

Claims that have crossed the carrier filing limits will be identified and the reasons will be analyzed, validated and subsequently adjusted off the accounts receivables.

Following the above steps, all remaining claims are again sorted by value and carrier.