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We provide Amazing Solutions

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Eligibility Verification

Verify Patient’s Insurance coverage & Demographic information with InsurancePat. A/c ‘s with issues are mapped with appropriate status code. Eligibility Reports forwarded to corresponding site location and the front desk @ site location rectifies the invalid (or) missing patient. A/c information.

Medical Billing/Coding

Client scans super bills and uploads the scanned files on to a secured server located at client’s office. Trans-quest downloads the scanned Super-bills and distributes the files for Coding.

Our CPC certified coders analyze each super-bill and code as per the guidelines set by CMS and AMA. The coded Super-bills are then examined for any possible errors by a well experienced CPC certified coder

Audited Super-bills are sent to the Charge Entry team to create claims in Client’s PMS system

Patient Registration & Entry

Scanned patient’s demographics and the coded Super-bills are sent to the Entry team to create claims in Client’s PMS system.Each patient’s scanned record is analyzed. The analysis reveals the patient’s history with the institution, i.e,new patient or an established patient.

If it is a New patient, then,we create an account in Client’s PMS system.

If it is an Established patient, we update the patient’s A/c.

We create claims in the client’s PMS system based on coded Super-bills. Through an in-depth audit of claims data, we ensure optimal quality levels prior to claim submission

Claims Process Management

Primary & Medicare Secondary Electronic: Primary & Secondary Medicare electronic claims are submitted directly to Medicare which connects through the Client’s PMS system from the central billing location.
Care-First and various other commercial Insurance claims are submitted through a clearing house (Emdeon/Proxy Med).
EDI claim acknowledgement reports are retrieved and analyzed to trace any rejected claims within 24 hours of transmission.
All rejected claims are resolved by taking corrective actions and re-submitted on the same day.
Paper Claims: Paper claims are queued on the client’s practice management system so that they are printed on a CMS 1500 form at the client’s office. These are then mailed to various insurance companies accordingly.

Payment Posting & Reconciliation (Auto Posting / Manual Posting)

Scanned EOB’s are downloaded from Client’s office at Trans-quest and distributed among the Payment posting team to further process those batches
Payment team will create a batch and set the target value to be posted in Client’s PMS system
Analyze each EOB and post payments, adjustments or flag denials in Client’s PMS system as per the scanned EOB files
Batch log is printed from Client’s PMS system to reconcile the batch posted and audit transactions by the posting team
Thorough audit by experienced payment team to ensure optimal quality levels in transaction posting

Accounts Receivable Management

The AR Analyst receives the work order from the Cash posting department on all the Unpaid / Part paid claims and after analyzing the Unpaid / Part paid claims report, the analyst identifies the claims that need to be further researched. They then allocate the work order to our AR team.
A weekly Insurance receivable summary and detailed report are generated from the client’s PMS system by our Analyst team for claims that are 20 days past billed date.Work orders are then distributed by the Analyst team based on the Age of the Ins. AR and Filing / Appeal limits of outstanding claims.The A/R Analyst takes final action on the claims worked on by our AR team and who in turn forward reports to the client if additional information is needed to resolve issues in balances.