Up to 40% of claims are known to have missing or inaccurate information, which leads to delays, denials and often-times, write-offs. Couple this with the fact that up to 50% of denied claims are never returned for processing, and one can see the tremendous benefit that a healthcare provider will enjoy by getting the claim processed correctly the first time. Lost revenue, increased expense and frustrated patients; these are just some of the challenges that result when a claim is suspended or rejected by a payor. Add to this the penalties imposed if Federal and State laws and guidelines governing the appropriate accounting of all gross receipts billed and net revenue received are not followed, one can begin to clearly see how vital the pre-claim adjudication process is to a healthcare organization such as yours.
At Credence Global Solutions, we understand that getting paid faster is essential to the health of your business. Credence provides comprehensive RCM solutions that include Billing Solutions – Demo/Charge Entry, Insurance Discovery, Eligibility Checks, Benefits verification, Claim Submission, HRSA Management, Edits and Rejections, Accounts Receivable (AR) follow-up, Denial Management, Payment posting and reconciliation, Patient statements and several patient contact programs. At Credence we triage each claim in order to maximize the reimbursement you receive for work you have already performed:
Insurance Due Diligence Discovery – ID3
Insurance Eligibility and Benefits Verification
Charge Entry and Billing
HIM Solutions (ICD-10 CM and Professional Coding
Credence Global Solutions offer intelligent automation
Credence Global Solutions provides intelligent automation for the pre-adjudication process. This means that eligibility checks, flagging of potential denials, remittances against contract expect pricing and electronic payment posting are all automated. Credence also provides connectivity.
Thus, our solutions will identify and fix holes in formatting and mapping while also actively reviewing and managing submission deadlines. It will also flag problems, such as missed payments or incomplete payments. By implementing this technology, it allows the billing staff to manage and deal with aging claims in real time rather than after the fact as payers have time limits.