Insurance Verification & Eligibility
We provide comprehensive Insurance Verification and Eligibility services to ensure that your healthcare claims process is smooth and efficient.
- Verification of co-pays, deductibles, and co-insurance to ensure accurate patient financial responsibility
- Pre-authorization and referral management to secure necessary approvals before treatment
- Verification of the correct payer for claims submission, whether it's a direct payer or a Third Party Administrator (TPA)
- Real-time eligibility checks tailored according to the provider's specialty
- Access to the latest insurance policy updates and benefit details
- Reduction of administrative workload by outsourcing insurance verification
- Custom reports for clear tracking and management of insurance verification status
Insurance Verification System
Real-time Eligibility Check
Patient Information
Patient ID
P-2024-001
Full Name
John Smith
Date of Birth
1985-03-15
Insurance ID
INS-789456
Insurance Provider
Blue Cross Blue Shield
Policy Number
BCBS-2024-789456
Claim Coding & Submissions
We provide professional medical claim coding and submission services to ensure fast, accurate, and compliant billing.
- We submit all claims with accurate ICD-10 codes, CPT codes, and the correct modifiers
- Our team carefully reviews each claim against clinical documentation to ensure proper and compliant coding
- We consistently maintain a 98% first-pass clean claim rate
- We submit claims within 24 hours of the patient's appointment to avoid delays
- Before submission, we scrub every claim using advanced tools to catch and fix any potential errors
- We perform pre-submission quality checks to reduce denials and improve reimbursement speed
- We handle claim submissions for all types of payers including commercial insurance, government programs, workers' compensation, and auto insurance
- We send both electronic and paper claims, depending on the payer's requirements
- We ensure all coding is HIPAA compliant and aligned with current payer guidelines
MCP Joints
(Metacarpophalangeal)
(Metacarpophalangeal)
The knuckle joints where fingers meet the hand
Common codes: 26530, 26531, 26535
PIP Joints (Proximal
Interphalangeal)
Interphalangeal)
Middle joint of each finger
Common codes: 26540, 26541, 26545
DIP Joints (Distal
Interphalangeal)
Interphalangeal)
Tip joint of each finger
Common codes: 26540, 26541
Wrist Joint
Connection between hand and forearm
Common codes: 25120, 25125, 25126
Denial Management & Rejections
We identify the root causes of rejections and denials, using advanced EDI systems to track, correct, and resubmit claims promptly minimizing revenue loss.
- We proactively manage both EDI (clearinghouse) and insurance rejections, ensuring your claims never go unnoticed
- Our team reviews and addresses rejections within just 24 hours, helping you avoid Timely Filing Denials and revenue delays
- With deep industry expertise, our specialists can effectively resolve every type of denial—no matter how complex
- Whether its documentation issues, coding errors, or billing mistakes, our experienced team handles it all with precision
- We take prompt action by sending reconsiderations and appeals to resolve any discrepancies and push claims forward
- Stay informed with our detailed denial reports, including pattern analysis and real-time recovery updates
- Partnering with us means your denial rate can drop as low as 1.5% to 2% a significant improvement to your revenue cycle
Denial & Rejection Management
Manage claim denials and rejections with automated workflows
1
New
1
Review
0
Appealed
1
Resolved
$514.50
Total
John Smith
New
$150.00
CO 18
Denial Reason: Prior authorization required
Notes: Need to obtain prior auth for procedure
Notes: Need to obtain prior auth for procedure
Sarah Johnson
Under Review
$275.50
CO 97
Denial Reason: Duplicate claim
Notes: Investigating duplicate submission
Notes: Investigating duplicate submission
Michael Torres
Resolved
$89.00
CO 4
Denial Reason: Service not covered
Notes: Appealed successfully payment pending
Notes: Appealed successfully payment pending
Payment Posting
We accurately post insurance and patient payments to ensure up-to-date account balances and complete financial transparency.
- We post EOBs and ERAs from insurance payers promptly into the billing system
- We verify payment amounts, adjustments, and write-offs against payer contracts
- We identify underpayments or non-payments and flag them for AR follow-up
- We apply patient payments (copays, deductibles, etc.) accurately to the correct accounts
- We maintain detailed records of all posted transactions for audit and reporting purposes
- We communicate with the AR team to escalate any discrepancies found during posting
Payment Posting
Quick payment posting with 1-2 click workflow
4
Total
4
Pending
0
Posted
$470.50
Total
Pending Payments
John Smith
ID: P001
Reference: CHK-001234
$150.00
Check
pending
Sarah Johnson
ID: P002
Reference: CC-567890
$75.50
Credit
pending
Mike Davis
ID: P003
Reference: INS-789012
$200.00
Insurance
pending
Emily Wilson
ID: P004
Reference: CSH-334455
$45.00
Cash
pending
✅ All payments posted successfully!
Accounts Receivable (AR)
Our Accounts Receivable service focuses on managing the full lifecycle of unpaid insurance claims.
- We actively follow up on claims every 10 to 15 days to ensure they are received and processed by the payer on time
- We perform weekly follow-ups on all outstanding claims to minimize delays in insurance payments
- We identify and minimize EDI and payer rejections by resolving submission errors before resending claims
- We take timely action on denials by fixing issues and resubmitting corrected claims
- We handle reconsiderations and appeals with proper documentation to recover denied or underpaid claims
- We maintain detailed AR aging reports and follow-up logs to track claim status and ensure no revenue is left uncollected
Accounts Receivables Calculator
Real-time AR Analysis & Aging Report
Total Billed
$125,000
Total Collected
$98,000
Outstanding AR
$27,000
Collection Rate
Percentage of billed amounts collected
78.4%
Good
Average Days Outstanding
45
Days
Good
Reporting & Analytics
We provide a shared reporting platform where providers can access all essential reports anytime, ensuring full transparency and control over their billing and collections.
- Daily Insurance Verification Report to track eligibility and coverage status
- Daily Claim Submission Summary to monitor how many claims have been billed and how many remain unbilled with reasons
- Daily Insurance & Patient Payment Posting Report showing all posted payments
- Real-Time AR Aging Working Report for up-to-date tracking of outstanding claims
- Weekly & Monthly AR Aging Summary to review outstanding balances over time
- Monthly & Quarterly Review Reports highlighting progress, improvements, and work done on your behalf
Practice Analytics Dashboard
Click to view comprehensive practice reports
💰 Financial Summary - Current Month
Total Revenue
$125,430
Collections
$98,250
Outstanding AR
$27,180
Collection Rate
78.3%
📊 Denial Analysis - This Month
Prior Authorization34%
Duplicate Claims22%
Coding Errors19%
Eligibility Issues25%
👤 Provider Performance
DR
Dr. Reynolds
142 claims · $48,200 billed
94.2%
DR
Dr. Martinez
98 claims · $36,750 billed
81.5%
DR
Dr. Patel
115 claims · $40,480 billed
72.8%
⏱️ AR Aging Report
0–30 Days
$14,200
31–60 Days
$7,840
61–90 Days
$3,290
90+ Days
$1,850
✅ Report exported successfully!
Appointment & Scheduling
Professional appointment scheduling, confirming, and reminder services to keep your practice organized and efficient.
- Booking, confirming, and rescheduling appointments
- Automated patient reminder calls, texts, and emails
- Management of provider calendars and schedules
- Integration with your existing practice management software
Appointment Calendar
Patient appointments & insurance status
September 2024
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Charge Entry
Accurate and timely entry of CPT, ICD, and modifier codes, strictly following NCCI guidelines to ensure clean claims and faster payments.
- Review of superbills and patient charts for accuracy
- Application of correct CPT, ICD-10, and HCPCS codes
- Adherence to National Correct Coding Initiative (NCCI) edits
- Reduction of coding-related denials and compliance risks
Charge Entry System
Enter CPT codes, ICD-10 codes, and modifiers for medical billing
CPT Code Selection
Search CPT Codes
ICD-10 Code Selection
Additional Details
Quantity
Modifier
Charge Entries
No charge entries added yet