OPBS Packages - Platinum Package
- Insurance verification
- Pre-certification
- Paperwork
- Charge entry
- Electronic claim submission
- Claims follow-up
- Billing of patients’ accounts
- Collections old A/R
Includes:
Insurance Verification
- Contact primary, secondary and tertiary insurance plans for benefits
- Verify lifetime maximums
- Verify out of pocket limits
- Verify deductibles
- Verify co-insurance or co-payments
- Verify benefits in or out of network benefit
- Determine if Pre-Authorization or Pre-Determination is necessary
- Contact patient to inform them of their out of pocket expense*
- Set up payment arrangements with patients if necessary*
Pre-Certification / Pre-Determination
- Get Detailed RX*
- Get Letter of Medical Necessity*
- Diabetic Verification from PCP if necessary*
- Get L-Code justifications if necessary
- Get all necessary info from physician/PT/OT/hospital*
- Continual follow up until all paperwork received
- If Pre-Cert or Pre-Determination is denied we will file an appeal
- Re-verify insurance prior to delivery*
Charge Entry
- Verify delivery receipts match codes that were verified
- Enter all charges promptly after receiving delivery receipt (if all required paperwork is on file)
- Claims submitted daily
Claims Follow Up/Billing Patient Accounts/Old A/R
- Verify with payer after electronic submission that claim was received
- Posting of all insurance and patient payments to patients accounts. Appeal any denied claims
- Call insurance companies on any claims not paid within 30 days
- Send patient statements for balances owed after insurance payment(s) have posted
- Send out pre-collection and final demand notices to patients who do not respond to regular monthly statements*
- Receive and address calls from patients regarding their balances, and payment plans; to free you and your staff the time used to deal with this sometimes uncomfortable situation*
*These services are optional at no additional charge
