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Claims Review & Submission

Claim Review Process refers to the steps that Settlement Class Members or Authorized Representatives must follow to submit requests for claim review relief and review those requests. After the insurance company has paid all outstanding debts, the healthcare provider submits a claim to determine the amount of reimbursement they will receive. If you submit clean claims, the payer will pay you more quickly because the claim will spend less time in accounts receivable.

Accounts Receivables Follow-Up

In a healthcare business, the accounts receivable (A/R) follow-up team manages denied claims and reopens them so that the insurance carriers will pay them appropriately. The amount of money a client owes a company already rendered is measured by accounts receivable. Investors can better understand a company's or individual's overall financial stability and liquidity by looking at accounts receivable.

Eligibility & Verification

Healthcare providers must confirm each patient's eligibility and benefits before the visit to be reimbursed for the services provided. The state database that offers current data on a Medi-Cal beneficiary is called the Automated Eligibility Verification System (AEVS) eligibility. AEVS aids in determining which managed care plan the member uses to access their Medi-Cal benefits.

Payment Posting

Payment posting consists of viewing payments and a medical practice's overall financial picture. Additionally, it alludes to recording payments in the medical billing program. It offers a perspective on patient payments, insurance checks from ERAs, and insurance payments in EOBs. In essence, payment posting serves as the first defense in detecting payer issues. The team might be instructed to deal with problems, including rejections of medical necessity, non-covered services, and prior authorization whenever they are discovered.