The ProEDI will manage initial and ongoing credentialing with the appropriate payers in the practice region. As the application processes vary by payer and many insurance providers do not provide retro-authorization, The ProEDI perform pre-insurance verification to check eligibility regarding the particular insurance, requirement for any pre-authorization or referral, whether any copayment has to be collected, if the patient has met the deductible, the amount of co-insurance the patient shares, and whether the patient's insurance covers the service sought from the provider.
Accurate medical coding improves medical milling process.Certified medical coders ensure that your practice is using appropriate specificity ICD-10. Correct codes is the first step to do drive revenue and reduce denials for our speciality practices. Our certified provider credentialing experts have extensive experience and help you better understand revenue generated from specific codes and identify most profitable procedures. We provide support to update Superbill with new codes. We strive to create accurate medical Code by taking on all of the following steps.
The charges from the coded documents are entered into the particular patient account.The entered charges are audited by our software to ensure a correct claim is submitted before transmitting the claims to the insurance payer through the clearing house. We do enter charge on a daily basis, with checks in place to ensure that each patient encounter is captured for submission to the appropriate payer.
We electronically submit your claims within 24-hour. With a combination of our expertise knowldge and standard software, Once the charges are entered and audited, the claims are then filed with the payer electronically.The ProEDI has processes in place to ensure acceptance of the claim by the payer and make appropriate corrections to claims that would otherwise be denied.
The ProEDI accesses payment information in one of two ways: Electronic Remittance Advice files (ERA’s) are posted automatically to the patient’s financial account; and Paper Remittance Notices are forwarded to ProEDI upon receipt by the practice. The ERA's and Remittance Notices are heavily scrutinized by ProEDI team and our software to ensure appropriate payment.
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We follow up with patients for any pending balance due after the insurance claim is processed. With automated billing reminders, ProEDI periodically calls patients with outstanding charges and reminds them to pay. If no response is received from the patient, we move those balances to collections, generate a report for it and send it to you for further action.