Claim Transmission and Rejection Handling
A patient encounter is converted into a claim by our professional Billers. The diagnosis codes and the procedure codes are recorded in the claim. If the practice uses an EHR, the codes are picked from there and verified. Alternatively, the required information is picked from scanned documents (super bills or encounter notes). Modifiers are added where required.
The patient’s appropriate Insurance health plan is selected – could be her primary Insurance or a workers’ compensation carrier, depending on the type of claim.
All the other required data is entered. Claims are then transmitted electronically to the clearing house.
Vision has a strict Quality assurance process. Every claim created is first checked by an independent QA team to ensure all the data entered is correct and a “Clean Claim” is sent out the very first time.
The claims created are run through our proprietary Claim Validation software to scrub claims and pick up any data entry errors and ensure that only claims passing all edits are transmitted to the Clearing House.
Depending on the size of your practice and Provider’s personal preference, claims are transmitted daily or fixed days of the week.
Clearing house reports are promptly checked. Claims rejected, if any, are immediately corrected and re-transmitted. Continuous monitoring is also done to track any Payer rejections.
At Vision, we lay a lot of emphasis on keeping ourselves up-to-date on ever changing payer regulations and claim filing processes. This ensures that we are in compliance with the latest regulations and minimizes claim rejections / denials.
Whether you are a full Revenue Cycle Management client or have engaged us to help you with some tasks, we seamlessly become an extension of your office, collaborating with your front and back office team members. The result is improved efficiencies bringing in faster and higher reimbursements.