Revenue Cycle Management

Cash flow for your practice is key in allowing for growth, change and future planning. Managing the life cycle of a claim is key to the success of your cash flow. Having a plan in place to administrate the processes required to properly manage the flow of medical insurance claims is critical. We offer services that are essential to creating sustainable success in the Medical Model.

Medical Claims Management

• Claim scrubbing
• Electronic claims filing and verification of claim receipt
• Payment posting (Vision Plans & Medical Insurance)
• Claim denials management and adjudication

Clearinghouse Services (replaces current intermediary)

• All enrollments managed (Payer, Eligibility, Electronic Remittance Advices, Electronic Funds Transfer)
• Electronic Remittance Advice enrollments
• Electronic Funds Transfers enrollments and set up
• Insurance Eligibility enrollments
• Patient Statements (via the clearinghouse)

Insurance Verification Services

• Patient insurance eligibility available via a real-time portal through clearinghouse
• Detailed Insurance Verification through proprietary Insurance Verification & Eligibility System – IVES™

-Determines if Doctor is in-network with plan requested

-Verifies for Routine Vision coverage available under medical insurance plan

-Ophthalmic procedure codes (CPT) verified

Accounts Receivable Management and training

Credentialing

• New Plan Enrollments for both Medical Insurances and Vision Plans
• Specialized software for Automated Plan and Contract Enrollment
• Detailed reporting and tracking to expedite enrollment process
• Provider verification services
• Credentialing Maintenance (CAQH, Re-validations, Re-enrollments) Plan