- What do you need in order to appeal a claim?
- Who retrieves and compiles the required documents?
- How long does it take to receive payment through the appeal process or on aged accounts?
- How often will I be billed?
- Can you successfully appeal claims that are denied because the medical expense was the result of perceived illegal activity?
- What are your qualifications for making a clinical assessment of a patient’s care?
- How will I know which claims to assign to you?
- If I use your services, will you train me or my staff to perpetuate the program?
- Are you HIPAA compliant?
Q. What do you need in order to appeal a claim?
A. Copies of the following:
- Billings to the patient (UB-04, HCFA 1500, etc.).
- Explanations of benefits (EOB) from the insurance carrier.
- Correspondence from the insurance carrier.
- Notes on the patient’s account history.
- Medical records, including notes by physicians.
- Contractual agreements with the insurance carrier.
Q. Who retrieves and compiles the required documents?
A. If you are a facility or a group, there are three options:
- Your staff may gather the documents for us.
- Our staff will pull and copy the documents on site.
- We can retrieve the information electronically through a VPN connection to your software system.
If you are an individual, we will provide a list of the documents we need, and you may send them to us.
Q. How long does it take to receive payment through the appeal process or on aged accounts?
A. Although exact timetables vary, results are prompt. Accounts are worked immediately upon receipt and
are monitored to assure timely payment.
are monitored to assure timely payment.
Q. How often will I be billed?
A. Monthly, but only after you receive payment from the insurance company.
Q. Can you successfully appeal claims that are denied because the medical expense was the result of perceived
illegal activity?
illegal activity?
A. We will investigate each claim and review individual plan benefits. In many cases, this research has not been done.
Q. What are your qualifications for making a clinical assessment of a patient’s care?
A. Our staff includes registered nurses, and, by contract, we consult with physicians and therapists when necessary.
Q. How will we know which claims to assign to you?
A. You will benefit from having us investigate all the accounts you have written off during the preceding year.
But we will accept any of your insurance claim denials.
But we will accept any of your insurance claim denials.
Q. If I use your services, will you train me or my staff to perpetuate the program?
A. Yes. After we complete our contracted services, we can evaluate your needs and train you or your staff
accordingly.
accordingly.
Q. Are you HIPAA compliant?
A. Yes. We understand the need for compliance with regulations, especially those of Medicare and Medicaid.
We follow all rules, both state and federal, regardless of whether they are HIPAA based.
We follow all rules, both state and federal, regardless of whether they are HIPAA based.