Cambay Healthcare Introduction
Cambay Billing is a renowned multi-specialty Medical Billing Service Provider based in Florida, USA, that serves major medical billing specialties all over the world. Our Medical Billing Outsource Services Team is certified in all areas of medical coding and billing, and they work as an extension of your organisation, conforming to your culture and producing the best results! Join hands with us and begin concentrating on improving your earnings.
With us in tow, worries about collections would become a thing of the past. Our team of experts uses the best medical billing software and EHR to increase the revenues of your practice within the shortest period.
With our expertise in accounts receivable management, we ensure the most efficient and the maximum reimbursement for your practice.
Medical Billing Services
Prompt Claim Submission
- Electronic or Paper claim submission
- Daily claim submission
- Real time adjudication of claims
- Review and scrubbing of claims based on regulations
Efficient Claims Management
- Managing the underpaid claims
- Management of denied claims
- Re-submission of denied or underpaid claims
- Management of appeals made on denied claims
Effective Payment Processing
- Quicker collection of payments
- Prompt remittance of payments to the accounts
- Efficient paper remittance
Regular Follow Ups
- Daily follow up on claim delays and payment
- Follow up on returned claims and denials
Competent Insurance Verification
- Verification of patient’s eligibility for insurance and benefits
- Verification of plans, policy status and plan exclusions
- Verification of deductibles, co-insurances etc
Reliable Medical Coding
- Management of medical coding audits
- Validation of DRG/ICD-10-CM coding
- CPT Coding
Timely Collections
- Quick dispatch of patient bills
- Reminder calls and email to patients on outstanding bills
- Quick insurance collections
Our Credentialing Experts
Operating coast-to-coast and working with various types of payor and provider organizations, we have the expertise to help you maximize every dollar possible with our expert medical credentialing services. Whether you work at an academic medical center, health system, are a hospital employed provider, or large group practice, our deep experience working with credentialing departments across the United States ensures that you will receive the best credentialing solution for your organization.
- End-to-end credentialing, expirables management and re-credentialing solutions for all third party insurance, governmental and CAQH payors.
- Expirables management solutions to maintain all time-sensitive credentials.
- Re-credentialing solutions for all third party insurance, governmental and CAQH payor’s.
- Primary Source Verification (PSV).
- Quality assurance teams focused on preventing credentialing application rejections.
- Experienced account managers to manage every aspect of the credentialing process.
- Assessments to identify improvement opportunities.
Initial Credentialing And Re-Credentialing Services
- On-site/remote primary source documentation collection using our secure scanning solution.
- Rapid data entry into our credentialing workflow software.
- Comprehensive par/non-par analysis to identify which providers are par and non-par.
- Missing elements review to ensure all proper documents required to enroll your physicians.
- Application and signature page consolidation and management.
- Use of UPS, FedEx and/or certified mail to track and trend mailed applications.
- Dedicated application follow-up to ensure that are payor’s are actively processing your applications.
- Extensive payor contacts to escalate processing issues.
- Sophisticated reporting designed to track and trend all stages in the physician credentialing life cycle.
- Compilation of all Provider Identification Numbers (PINs) for easy billing system entry.
Re-Credentialing Services
- Conduct all re-credentialing services based on insurance plan requirements.
- Application and signature page consolidation and management.
- Use of UPS, FedEx and/or certified mail to track and trend mailed applications.
- Dedicated application follow-up to ensure that are payor’s are actively processing your applications.
Expiable Management Services
- Pro-actively monitor document expiration (e.g., license, DEA registration, board certification).
- Conduct all ongoing CAQH re-attestations.
- Expiring document report analysis to ensure advance notice that a document is soon to expire.
- Respond to provider enrollment billing issues/edits.
Delegated Credentialing Management
- Manage delegated credentialing rosters for all delegated payor’s.
- Manage weekly/monthly roster submissions.
Special Projects
- Medicare re-validation services.
- Group contract creation and enrollment.
- TIN consolidation and enrollment.
- Payor website analysis to ensure that your payor’s correctly list your provider data on their websites.
Our Services
Insurance companies require providers to update credentials on regularly If updates don't seem to be addressed on time, claims may be denied leading to an interruption of money flow.
We customize our services based on organizational needs. Below is a transient listing of the many of our credentialing services offered:
- New provider enrollment (All Payers/Multiple States)
- -- Commercial insurance credentialing
- -- Medicaid Provider Enrollment (including HMO’s)
- -- Medicare Provider Enrollment (including HMO’s)
- Professional License Renewal
- PECOS/ I&A updates
- Facility Privileging
- NPI Registration (Type I and type II)
- Demographic or Name Changes
- Proview (formerly CAQH) Enrollment Updates and New Registration
- Group & Individual Medicare Revalidation
- Payer update requests for changes in demographic/provider data
Insurance Verification
Irrespective of patients' integrity in disclosing factual information about their health insurance plans, it has been our first-hand experience that the physician reimbursement rate is directly linked to the quality of Insurance Verification adopted by their medical billing staff. The realization has given rise to a comprehensive Insurance Verification process that is quite capable of verifying the factual information furnished by the patients during their enrollment for medical service.
As you consider adapting Verification Process that is capable of serving your comprehensive needs, our unique Insurance Verification following a streamlined questionnaire should prove to be an ideal choice:
- Does the patient have an effective health plan with the insurance carrier?
- What is the effective date of coverage?
- What type of plan is the patient covered under – HMO, PPO, or POS?
- What is the patient's co-payment responsibility?
- Does the patient have a deductible? If yes, how much is the deductible and how much of the deductible has been met?
- Does the patient have other out-of-pocket expenses?
- Does the patient have medical benefits for treatment?
- Does the treatment require prior-authorization?
- What is the prior-authorization dept. phone number? Who is your primary contact?
- Is a referral from the primary care physician or other referring physician required?
- Does the referral have to be submitted to payer prior to rendering services?
- Where should you submit the referral?
- How do you establish the factuality of patients' addresses?
Consequent to such streamlined Insurance Verification you can expect your claims to be delay and denial free, and less prone to stringent audits by your insurance carriers. Thus, our ingenious Insurance Verification – offered both as a separate component as well as integral part of our comprehensive suite of Medical Billing Revenue Cycle Management – will eventually bring down your Account Receivable Cycle within the permissible limit, prove operationally viable, enhance revenue generation, and foster quality medical care.
Our qualified and competent team of medical billing specialists, comprising a diverse mix of professionals drawn from different specialty-specific disciplines, will make sure that you have your patient’s insurance plans thoroughly verified against intended medical services.
Authorizations/Referrals
Pre-authorization, prior approval, or pre-certification, all of these terms mean the same thing – obtaining prior approval from an insurance (payer) before a doctor provides services to a patient. This confirmation by the payer that a procedure, treatment plan, medical equipment, or prescription drug is medically necessary provides an authorization number that has to be included on the claim when submitted.
A referral, on the other hand, is when a primary care physician (PCP) recommends a patient to a specialist for consultation or healthcare services they are unable to provide. Many insurance companies require this step before agreeing to pay for a visit to a specialist. To file a successful claim, you have to make sure you have this referral on file for your patients.
These steps in the revenue cycle management are critical. Obtaining pre-authorizations or ensuring you have a referral can provide several advantages:
- Accountability and Cost Containment
- Reduction of Denials and Enhanced Collections
- Reduction in write-offs
- Increase in Revenue
The process for obtaining prior authorizations and referrals can be done in many ways such as:
- Phone Calls
- Online Forms
- Faxes Sent Through PMS
All of these take time and add an administrative burden on your staff! Time that could be better spent ensuring the quality of patient care is delivered and maximized. Also, your staff needs to be aware of a variety of different payer’s guidelines, which continually change. Staying ahead of all of these changes is time-consuming as well.
Billed Right helps save you time and reduce your denials!
Understanding all of the ins and outs of obtaining pre-authorizations and referrals is important in avoiding lost revenue and negatively impacting your practice financially. Billed Right has the expertise to help you manage what can sometimes be a very complex process.
To learn more about how Billed Right can help you with authorizations and referrals contact us today!
OUR EXPERTISE
Outsourcing Prior-Authorization/Referrals is the Best Option
At Billed Right our Authorization & Referral service provides doctors with the additional resources to obtain necessary pre-authorizations/referrals and ensure claims are submitted with the required information for each payer, thus offering a more optimized workflow saving you time and money.
With our authorization/referral service you can expect:
- A virtual prior authorization resource
- Submission of request within 12-24 hours
- Track record of the authorization and referral steps completed
- Notification if a peer-to-peer review is requested
- Work done through Practice Management System
- Communication with staff on approvals and denials of auth and referrals