Here's what a claims processing provider needs to do for you

Here’s what a claims processing provider needs to do for you
With new legislation, changing corporate structures and ever-shifting benefits models, dealing with health care claims can be a complicated and costly process.


The solution? Finding an experience, reliable provider that can handle those duties for your organization. Among the benefits of outsourcing your medical claims processing:

  • Increased profits as a result of expedited claims processing
  • Decreased transaction costs
  • Less time and money invested in overhead functions that have little impact on the outcome of claims
  • Secure online access
  • Guaranteed sharp images of documents, X-rays and bills
  • HIPAA compliance and protection, as well as compliance with other state and federal regulations – and  industry regulations
  • Audit trails allowing for real-time reviews and complete transparency of the claims process

One more thing: To enjoy those benefits, when you choose a provider for outsourcing your medical claims needs, be sure it’s a reliable company with a proven track record of working with a variety of claims-related forms, including:

  • CMS 1500
  • UB92
  • Pharmacy forms
  • Prescription receipts
  • ADA forms
  • Dental X-rays
  • Provider-defined “Superbills”
  • Network claim forms
  • Pricing sheets
  • Explanation of Benefit (EOB) statements

Insurers have a variety of different business rules and requirements for processing. The right medical claims processing provider will understand not only these rules and requirements, but will also work with your team to design a workflow that fits your specific needs while giving you guidance to best practices.

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