Claims Management Services

Clean Claim Preparation

• The first step to a successful reimbursement is a clean claim.
• All claims are reviewed by our experts prior to being submitted, to ensure accuracy.
• completeness.

Clean Claim Preparation · Services Include

• Claim creation
• Identification and validation of diagnosis and procedure
• Patient demographic verification
• Insurance verification
• Charge validation
• Modifier verification
• Medical necessity review
• Claim completeness assessment
• Benefits
• Higher first-pass acceptance
• Fewer rejections
• Faster reimbursements

Electronic Claims Submission · Our Process

We submit claims electronically via major clearinghouses and ensure that we are compliant with the claims submission process.

• Electronic claim generation
• HIPAA-compliant transaction processing
• Clearinghouse submission
• Batch claim processing
• Timely filing management
• Payer-specific formatting
• Submission confirmation
• Electronic acknowledgement monitoring

Claim Scrubbing & Validation

• All claims are subjected to several quality checks prior to submission to detect errors. could delay payment.
• Validation Includes
• Coding validation
• Demographic review
• Coverage verification
• Modifier validation
• Duplicate claim detection
• NCCI edit review
• LCD/NCD compliance review
• Payer-specific rule validation
• This helps to minimize preventable claim denials substantially.

Claim Status Monitoring

• Our Claims Specialists continually track the progress of your claim from submission to completion adjudication.
• We Track
• Claim acceptance
• Pending claims
• Payer processing status
• Documentation requests
• Suspended claims
• Payment timelines
• Outstanding claims
• Claim aging
• Providers get full transparency of all claims submitted.

Claims Follow-Up

Follow up ensures that claims move in a timely fashion through the reimbursement process without unnecessary delays. Our specialists are in direct communication with insurance carriers to:

• Verify claim status
• Resolve processing issues
• Submit additional documentation
• Correct claim errors
• Escalate unresolved claims
• Expedite delayed payments

Rejected Claims Management

There are no claims that are rejected that go to adjudication; they must be corrected immediately. Our rejection management process is:

• Root cause analysis
• Data correction
• Clearinghouse issue resolution
• Payer formatting adjustments
• Resubmission
• Trend reporting

Denied Claims Management

• Denials are recoverable revenue, if managed properly.
• ZechionMed offers full denial management.
• Services Include
• Denial categorization
• Root cause investigation
• Clinical documentation review
• Coding review
• Appeal preparation
• Corrected claim submission
• Payer negotiations
• Recovery tracking

Claims Appeals Management

• Our expert reimbursement experts create in depth appeal packages backed by By proper clinical documentation and guidelines from the payers.
• Appeal Services
• Medical necessity appeals
• Coding appeals
• Authorization appeals
• Timely filing appeals
• Underpayment appeals
• Clinical documentation support
• Provider communication
• Appeal tracking

Secondary & Tertiary Claims Processing

• Many patients have a variety of insurance policies that must be coordinated.
• We manage
• Coordination of Benefits (COB)
• Secondary payer billing
• Tertiary payer billing
• Medicare crossover claims
• Commercial coordination
• Patient responsibility calculations

Payment Reconciliation

• All payments are reconciled with the amount that is expected to be reimbursed.
• Our specialists perform
• ERA reconciliation
• EOB review
• Payment verification
• Underpayment identification
• Contract compliance validation
• Adjustment analysis
• Revenue reconciliation

Underpayment Recovery

• Sometimes, insurance companies will pay less than contract rates.
• We locate and reclaim underpayments using
• Contract analysis
• Payment comparison
• Variance reporting
• Recovery requests
• Negotiation support
• Reimbursement monitoring

Claims Analytics & Reporting

• Data can be used to make decisions that drive better financial results for healthcare organizations.
• Our reporting includes
• Clean claim rate
• First-pass acceptance rate
• Denial trends
• Rejection analysis
• Aging reports
• Payer performance
• Reimbursement trends
• Revenue forecasting
• Executive dashboards

Claim Validation

• Run full quality checks, payer-specific edits.

Electronic Submission

• Provide clean claims via secure clearing houses.

Claim Monitoring

• Monitor the progress of claim(s) during adjudication.