Medical Billing and Claims Processing Support

Charges are entered into your billing system from the documentation you provide, then checked back against that documentation for completeness and internal consistency before a claim is built.

Procedure code data is processed as it appears on your documentation and validated against your established workflows and payer edits. This is coding-data validation support, not independent clinical coding.

Diagnosis code data is handled the same way: taken from your documentation, checked for completeness and for consistency with the procedure data. We do not assign a code your documentation does not support.

Modifiers are applied from the rules you document, not from interpretation. Where a modifier is ambiguous under those rules the charge is held and queried rather than assumed.

Dates of service are checked against the encounter record, because a correctly built charge on the wrong date is a clean claim that will still be denied.

Rendering and billing provider details are validated against your provider file, so a claim does not go out under the wrong identifier or the wrong billing entity.

Place of service is checked against the encounter, because the setting a service was delivered in can change both the allowed amount and whether it is covered at all.

Charges are worked in batches tied to your schedule, each one logged and counted on receipt, so a missing day is visible immediately rather than at month end.

The batch is reconciled against the encounter list, so an encounter carrying no charge is found while it is still inside the filing window.

Claims are built from validated charges inside your system, with payer, plan and subscriber details carried through from registration rather than re-keyed at the last step.

Claims are run against your payer and clearinghouse edits before submission, so the predictable rejections are caught on our side rather than on theirs.

Claims are submitted through your clearinghouse and payer portals on the batch schedule agreed during transition, with each submission recorded against the claim.

Paper claims are produced and sent where a payer still requires them, with the same validation applied and the same record kept as for an electronic submission.

Rejections are identified and categorized by reason as they come back, rather than accumulating in a report nobody opens until the end of the month.

Claims are followed from submission through to acceptance or adjudication, so a claim that silently never arrived is found rather than assumed to be processing.

Rejections are corrected against the reason given and documented on the account. Where the fix needs a decision only your team can make, it comes back with the proposed correction attached.

Corrected claims are resubmitted and reconciled against the original batch, so what was sent, what was rejected and what was fixed all account for each other.