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Claim Processing


Printing paper claims and submitting electronic claims

Sending clean and accurate claims is the key to full insurance reimbursement. That's why Billing Paradise helps you send electronic claims to thousands of payers, print national and state-specific paper claims, and receive electronic claim processing reports. It helps you maximize insurance reimbursement while safeguarding your physicians' cash flow against any disruptions.

Submit Electronic Claims

You can use Billing Paradise to send primary and secondary electronic claims to more than 2,500 government payers and commercial insurance carriers nationwide. We help you set up connections to thousands of commercial insurance companies and closely manage the enrollment process for government and Blue Cross / Blue Shield payers. Once you set up your master insurance list, you can submit claims immediately.


Print Paper Claims

Some insurance claims, such as those that require additional paper attachments, must need to be submitted on paper claim forms. You can configure different claim forms for primary and secondary billing scenarios. For most insurance companies, you'll use our standard CMS 1500 Form or our newer CMS 1500 Form with support for the new National Provider Identifier (NPI) numbers. For certain payers, you can also tap into our library of state-specific and workers' compensation claim forms. Finally, you can customize the provider and group numbers that appear on your forms using advanced settings.

Receive Claim Processing Reports

Billing Paradise provides multiple levels of reporting as your claims make their way through the medical insurance billing companies and adjudication process. Once you submit your claims, our systems automatically review all of your claims and return internal validation reports to highlight claims with missing information, such as missing provider or group numbers, missing patient information, or incorrect policy numbers. Once your claims pass our internal validation, we forward your claims through one of several clearinghouse partners who also review your claims and return daily reports that highlight claims that have been rejected for various payer-specific reasons. Once your claims are delivered to payers, the payer may respond with reports highlighting claims that have been rejected for various reasons prior to the adjudication process. Finally, you may receive electronic remittance advice (ERA) reports once payers process your claims and issue payment.

Set up Advanced Business Rules

You can take advantage of our advanced claim printing rules engine to handle attachments, workers' compensation billing scenarios, or other unique situations. You can configure different claim forms per state, billing scenario (e.g. Medicare, workers' comp, etc), and/or procedure code. You can set up rules to print and pre-collate attachments, send copies of claims to multiple recipients, and even print envelope labels.


This post first appeared on Medical Billing Services Now Offered By Coders, please read the originial post: here

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