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Home
> Pre-Billing
System
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I. Insurance
eligibility/benefits verification
Improper eligibility
checking is the number one cause for claim rejections.
In order to solve the problem dmbi uses a combination
of monthly eligibility/capitation lists, online
insurance company websites, and automated phone
systems to verify if the patient has active or inactive
coverage. This includes checking to see if office
visit co-pays have been updated, deductibles have
been met, or if any specific procedures, such as
vaccine administration, are covered. |
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II.12 Hour
Claim Entry
Claims
are entered within 12 hours of receiving information
regarding the patient's visit. Through the use of
high level scanners and file transfer protocols
superbills/route slips/encounter forms are received
from any doctor's office regardless of practice
size and location. Claims are generated for every
type of patient care including office, hospital,
and nursing home. Intense scrutiny is given to every
claim generated and any missing details are requested
from the doctor's office before transmission. |
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III. Clearinghouse
report tracking
A significant number
of all claims sent electronically (15-20%) are never
processed at all due to failed transmission at the
clearinghouse level. Dmbi tracks every single claim
transmission and verifies its successful submission
by using an online tracking utility which receives
confirmation and denial status from the clearinghouse
and electronic payers. Claims with expired icd/cpt
codes and missing demographic information are corrected
and resent immediately. |
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