As Healthcare Organizations and medical group practices search for means to better serve their patients, the challenge to create a paperless environment, utilize less staff while increasing productivity is becoming necessary. Some Organizations find it necessary to rely on their Front office to enter patient data, while at the same time, find it necessary to outsource claims auditing and submission to professionals.

As a Claims Auditing and Processing Center, Advanced Healthcare Solutions, Inc. provides:

• Ability to receive claims in NSF 2.0 Format and re-transmit in X12N Format
• Electronic Data Retrieval (various formats)
• Electronic HCFA 1500 & UB92 Claims Submission
• Common Access To Over 650 Payers
• Receipt and printing of paper claims
• Capabilities to receive and transmit in X12N format
• Hard Copy Claim Submission [If Applicable]
• Secondary Claims Processing
• General Audit For Accuracy Of Data
• Complete Coding Audit [ICD-9, CPT, HCPCS, CPT Modifiers, Coding Links To Related Data]
  1. Identify Incomplete Codes
  2. Identify Invalid and/or Obsolete Codes
  3. Identify Use Of Unspecified and Non-Specific Codes
  4. Validate Codes to Service Descriptions
  5. Audit For Proper Facility and Service Type Codes
• Audit For Subsequent Attachments
• Audit For Necessary Authorizations
• Audit For Accuracy Of Payer I.D. and Carrier Locations

Clients utilizing our Claims Processing Services benefit by:

• Increased Cash Flow Due To Faster Turnaround Time On Reimbursements From Payers.
• Payer Acceptance Rates Over 95%
• Paperless Environment
• Reduction In Days In Accounts Receivable
• Reduction In Staffing Needs
• Elimination Of Postage Costs and Mail Handling
• Elimination Of Tedious Paper Claim Handling
• Reduction In Office Supply Costs

Claims Auditing and Processing Fees are usually priced per claim, and/or per transaction and are individually quoted based on the Medical Specialty, the size of the Healthcare Organization, and services provided. Per claim fees can range from $ .45 to $3.50, depending on services provided. All fees are competitively scheduled to meet the standards of the marketplace. (A monthly service fee may apply)