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
- Re-verify insurance prior to delivery
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 let them know how much they will owe at the time of service
- 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 matches codes that were verified
- Verify that Detailed RX, LMN, diabetic verification and all other paperwork in order
- Enter all charges within 24 hours of receiving delivery receipt (if all necessary paperwork is already on hand)
- Claims submitted electronically on a daily basis to all carriers who accept electronic claims - Paper claims also submitted daily
Claims Follow Up/Billing Patient Accounts/Old A/R
- Call insurance 15-20 days after submission to verify that they did receive the claim
- 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
- 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
