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Compare the reimbursement rates offered by insurance agencies with the existing market rates and norms.
Periodically review the contracts at regular intervals, in line with the current situation.
Complete all necessary credentialing requirements for the preferred payers and plans and follow until approval.
Review the contract, reimbursement rates, responsibilities of participation and ensure the provider understands the terms prior to the agreement.
Identify the ERA/EFT enrollement requirements, verifies current provider ERA/EFT setup and co-ordinate with the provider for recommended changes.
Fill up the necessary applications on your behalf, interact with payers through successful ERA transmission and bank deposits.
Create and Manage CAQH profile with periodic review and attestations. Reporting expires, re-credentialing dates, licenses & DEA.
Assure the highest standards of coding quality, with quality checks occurring throughout the process.
Evaluate the EDI enrollment needs, coordinate with the clearing house and the payers to facilitate the process.
Complete the necessary applications, perform EDI setups and interact with clearinghouse and payers until a successful transmission.
Analyzes all the disciplines of revenue cycle to identify potholes, root causes and recommend the best practices to fix issues, streamline process and maximize revenue.
Recommendation and implementation of new billing systems after a complete study of the current business set up and requirement.
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