Claims Review and Investigation

Send us your insurance EOBs and associated medical bills. We’ll review them for accuracy and let you know whether they’re correct and ready to pay or are in need of further investigation.

Verification of Benefits

Not sure if a certain service or procedure is covered by your plan? Pretty sure something’s covered, but you don’t understand the details? Let us figure out the details for you.

Identification of In-Network Providers

Seeking services from an out-of-network provider is one of the most common ways to get stuck with a larger-than-necessary medical bill. Whether you don’t have the time or you just don’t know where to begin, we can help you determine whether a provider or facility is in your insurance network prior to services being rendered.

Appeals

Appeals usually result when your insurance company denies something that you believe should have been covered. An appeal is very time-consuming and somewhat of a last resort in claims processing and usually requires:

• medical records
• a letter from the patient and/or provider
• some kind of proof that the patient and/or provider was under the impression that the services would be covered before they made the decision to move forward with said services.

An appeal goes over better when submitted by someone with a clinical background or someone who can at least “talk the talk” (such as a physician, nurse, or patient advocate), as it will be reviewed by a nurse or physician who works for the insurance company and compared to your specific policy coverage to determine whether services that were initially denied should actually be covered.

Simple Claims Resubmission

Submission to an incorrect insurance payer is a common mistake in medical billing.

• Perhaps you changed insurance plans and forgot to give your physician’s office your new card.
• Maybe you did give your physician’s office your new card, but they failed to make appropriate updates before sending out your claim.
• Or, maybe your physician’s office had your new insurance on file correctly, but the facility where they sent you for services failed to get the memo…so, they pulled up the old insurance you had when you were there 10 years prior and submitted their claim to them.

No matter the scenario, we’ll get to the bottom of it and make sure your claims are resubmitted correctly.

Corrected Coding

Every claim submitted to insurance for reimbursement must have a diagnosis code, a procedural code, and, potentially, a HCPCS code. There are a lot of codes out there–and a lot of coding guidelines to be followed. Which means a lot of room for error. We’ll research your claims for potential coding errors, request medical records (if needed), and have any incorrectly-coded claims resubmitted to insurance for reprocessing.

Fee Negotiations

Oftentimes, even the largest of medical bills are correct…but that doesn’t mean they’re affordable. We’ll work with provider billing offices on your behalf to potentially reduce your balance and set up payment arrangements that you can manage.

Other Services

Have a problem or question regarding your health insurance or medical bills that you don’t see listed above? Contact us here and we’ll let you know if we can help.