Core Reimbursement Support Line Services:
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Coding and billing advice provided by expert coders to assist with the submission of clean claims to avoid payment denials. Our experienced coders and insurance specialists are familiar with the flow of services, billing and coding in the service sites that are important for products. We can assist callers with simple and complicated coding inquiries.
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Reimbursement tools hat can be developed to further educate callers and to facilitate the submission of clean claims include billing guides, coding sheets, letters of medical necessity and sample appeal letters of appeal are a valued hotline service.
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Benefit verification services. We believe that systematic and comprehensive benefit verification is the first step to ensuring appropriate patient access to products and services. Our reimbursement counselors are experts with formal training in techniques of performing a thorough benefit verification. We have developed a Ten Question Protocol for several different benefit verification and coverage cases to maximize efficiency in obtaining insurance information from qualified insurance carriers, patients and primary care providing physicians. Using this method minimizes the time spent on each call as well as time spent researching and solving medical coding and billing issues, allowing us to give accurate and timely results.
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Prior Authorization Assistance. We facilitate the prior authorization process on behalf of providers to the degree allowed by the payer. We report back the parameters of authorization to providers, including time frame, referral process (as applicable), coding requirements, and clinical criteria.
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Appeals assistance. Our reimbursement specialists are familiar with the latest changes in the Medicare appeals procedures and can assist in providing clinical rationale to support appropriate payment for patient care.
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Customized follow up services. We provide additional customized services to meet our client and account needs.
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Payer advocacy services. Hotline services regularly heighten to payer alliance services such as gathering and submitting clinical information, published articles or a letter of medical necessity, particularly for new technologies. We work together as a team by linking individual hotline reported denials of payer coverage with macro level negotiations with payers.
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Payer mailings. Our hotline reimbursement counselors frequently conduct payer mailings to help launch a product with payers and follow up to ensure that the materials are reviewed. The payer advocacy experts can be involved in higher level negotiations when necessary.
List of Hotline Success Cases
