1. Primary Service Modules

🔍 Front-End Patient Access & Eligibility

Prevent claims from getting rejected before the patient even walks through the door.

• Upfront Eligibility & Benefits Verification: Verifying patient coverage, copays, deductibles, and co-insurance details prior to appointments.

• Carve-Out & Secondary Coverage Identification: Ensuring third-party behavioral health coverage and secondary policies (COB) are identified correctly.

• Prior Authorization & Pre-Certification: Determining authorization requirements, submitting clinical documentation, and tracking status to eliminate care delays.

⚙️ Claims Management & Clean Submission

Keeping your cash flow predictable with accurate, timely submissions.

• CPT & Modifier Audit: Reviewing behavioral health billing codes (e.g., 90834, 90837, intake evaluations) for accuracy and compliance.

• Electronic Claim Filing: Submitting primary and secondary claims directly through clearinghouses within required deadlines.

• Clearinghouse Rejection Management: Fixing real-time front-end clearinghouse errors before claims ever reach the payer.

🛡️ Denial Resolution & Appeals (Back-End RCM)

Recovering revenue locked up in unpaid or stalled insurance claims.

• Denial Root-Cause Analysis: Reviewing payer denial codes (CARCs and RARCs) to pinpoint why claims stalled.

• Timely Filing Corrections: Correcting and resubmitting claims well within payer-specific Timely Filing Limits.

• Formal Written Appeals: Drafting and submitting detailed appeal letters backed by clinical notes and payer-policy guidelines for rejected claims.

• Accounts Receivable (A/R) Follow-Up: Tracking unpaid claims aging past 30, 60, and 90 days to recover outstanding revenue.