Claim Management

Claim management is a complex process. An inefficient or broken process means lost revenue.

Even with staff’s best intentions, rejected claims often are overlooked while staff juggle many other tasks concurrently.  As a result, claims often become untimely and are ultimately written off. As soon as a claim is rejected, the clock is ticking.  There is a small window to get claims corrected and reprocessed. Not getting claims paid for services provided should not happen – we will help you get rejected claims paid.

We specialize in medical claims resolution and process improvement to help your agency collect payment on services you provide.  Claims referred to us are logged into a tracking system, researched and processed usually within a few days of referral to us. Our tickler system assures that we submit claims within the timeframe required per each payer’s contract.  Claims are then monitored continuously until paid to assure the best results for our clients.

Claim Management services include:

  • Appeals & reconsiderations
  • Accounts receivable workflow monitoring
  • Claim submission
  • Credit balance analysis
  • Front-end rejections by clearing house
  • Revenue cycle management
  • Accounts receivable analysis and follow-up
  • Backlog claims projects
  • Claim tracking
  • Denial management
  • Identify rejection trends
  • Staff training
Our clients only pay a fee for those claims we resolve.
If claim payment is not obtained, there is no fee due to us.

Outsource problem claims to us to resolve or entire payers for us to handle from claim submission through payment. 

If you chose our monthly service option, for the average cost of one claim, we will monitor, resubmit and track all rejected and denied claims for your agency, automatically. This service greatly increases collections while assuring that every claim is handled promptly and effectively. For example, one client benefitted from this service as we collected claims over $150K per month, all for a small monthly fee.

Claim status reports and updates are provided to clients on a regular basis.

We handle Skilled Nursing, Homecare, Adult Day Heath Services as well as Therapy, Clinic and Group Practice billing.

We will help your agency collect what they should, even with the most complex claim issues. We have successfully collected on claims, even beyond the time limit per contract, by writing appeals and providing details why the claim must be paid.

You can refer claims in a few easy steps.
Click here to learn how the referral process works. You can also access the referral form by clicking here.

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Healthcare Consulting & Billing Solutions, Inc.
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