Help With Low Paid / No Paid Insurance Claims For Out of Network Billing
As treatment facility owners, we understand the costs of being distracted by insurance companies and the billing games they play. Here are a few examples:
- The insurance company will pay a very low “allowed amount” compared to the billed amount that cannot be justified (usually this is a debate over usual and customary billing for a specific region).
- Denials over medical necessity.
- Payments going to the client instead of the facility.
We face these challenges on a daily basis. The end result is wasted time, resources and money. This is valuable time that we could spend enhancing our client care.
ClaimPath grew out of an impossible situation that we found ourselves in with the insurance companies. The purpose of ClaimPath is to assist the treatment facility in the billing process. Once all methods have been exhausted by your team of internal or external billers, ClaimPath takes over, going after the “dead” money.
ClaimPath performs a detailed forensic audit using the electronic data systems of the insurance companies. Using simple data from the treatment center, such as patient name, date of birth, insurance policy number, admit date and discharge date, our team manually rebuilds all the billing data going back for 18 months. We locate every low paid or no paid claim and add it to our “to-do” data list. Then, our team goes to work by calling about each and every claim and documenting the call with insurance company reference numbers. The claim is then sent to one of our other 3 departments in order to get the claim paid higher. Our three departments consist of corrections, verbal reprocessing, and written appeals.