Reliant Health Insurance Management Services are Claim Processing, Insurance Management and Encrypted electronic transmission of claims for all insurance types - Medicare, Medicaid, Commercial, HMO, Managed Care Includes: Coordination of Benefits, Primary Insurance Claim Submission and Secondary Insurance Claim Submission
Paper Processing - All claims are initially sent electronically. Electronic claims are automatically "dropped to paper" when payor does not accept electronic claims. Paper claims are signature stamped and sent certified, first-class mail. We provide the signature stamp for use on paper claim submissions.
Abstracting - Medical records are abstracted to ensure diagnoses are to the greatest level of specificity and support medical necessity of procedures.
Risk Analysis - Assessment of medical record documents is done to help ensure coding compliance safeguards. The following is a partial list of "risk areas" that are monitored:
- unbundling
- billing for services not documented
- discounts
- duplicate billing attempts
- routine waiver of co-payments
- billing for unqualified personnel
- upcoding
- improper alteration of document
- professional courtesies
- assumption coding
- improper use of modifiers
EOB/EOMB Reconciliation - Payor payments to providers are reconciled to charged amount to identify denied services, down coding, payment reductions, contractual adjustments and withhold adjustments.
Claims Tracking and Follow-up - Status of submitted claims is routinely checked using insurance aging and analysis reports to identify the issues that cause claim denials and reductions. Payor reports are monitored to ensure payments are appropriate and made in acceptable time frame. Tracers are done when necessary. Supporting documentation is sent by our office to carriers that request additional information.
Allowable Tracking - Allowables paid by various carriers are tracked. Provider fees can be adjusted to capture more of available insurance dollars.
Reporting - Monthly Payor Analysis reports or as requested.
We work with you and your staff as closely as an in-house biller and save you money by, Eliminating billing employee expenses (salary, benefits, sick pay, etc), Lowering the cost of forms and supplies, Eliminating the high cost of hardware and software upgrading and updating, and Reducing your telephone expenses. |
All potential coders are required to complete a pre-hire test to determine if they have the aptitude to become a part of Reliant Health's highly qualified coding staff. All our coding staff receive an intensive training course prior to being assigned to a client. Finally, all Reliant Health coders undergo monthly audits to ensure continued compliance to our coding standards. Monthly coding meetings are held to update our staff the changes in coding procedures, and provide an opportunity for questions and answers. Reliant Health strictly follows AMA guidelines and uses only approved manuals such as: ICD-9-CM, CPT, and HCPCS manuals. 
