HealthPro’s Accounts Receivables (“A/R”) team is responsible for evaluating denied claims and reopening them to receive maximum reimbursement from insurance companies. A/R specialists seek to avoid complete write-offs by prioritizing unsubmitted claims approaching the 90-day window.
The process is conducted in three (3) primary stages:
Stage 1: Initial Evaluation:
Involves the identification and analysis of claims listed on the A/R aging report based on timeline and payor.
Stage 2: Analysis And Prioritization:
Primarily three (3) types of claims are analyzed: (1) claims where no payment has been made due to provider’s failure to file a claim, or due to a denial (2) claims where the carrier has made a partial payment, or the carrier has made a payment that is not in accordance with the healthcare provider’s contracted rate (3) claims where further information has been requested by the insurance company.
Stage 3: Appeal / Collection:
All appeals are submitted in a timely manner with all pertinent information. All balance billing for patients is processed electronically.