The Prime Service Difference

Billing & Collections

 

Our follow-up on claims is what truly separates Prime from the competition. Prime Medical Billing expert staff along with our medical billing software enable us to deliver the most efficient processing, management, and collection of your accounts. Our services include:

 

 

• Customized electronic claims processing

• Filing of secondary and tertiary insurance claims

• Submission of UB04 and HCFA-1500 claims for both facilities

       and individual providers

• Fee negotiations and single case agreements

• Advanced audit to ensure  error free claims submission

• Monthly patient statements

• Reporting on usuable, allowables & customary rates

• Customized weekly and monthly reports.

• Appealing denials

• Work closely with the insurance companies to expedite the processing of our claim

• Fight for higher reimbursement 

• Lower practice overhead

 

Utilization Management 

 

The Utilization Management team are staffed with registered clinicians who has both the clinical and administrative knowledge plus years of experiences working with insurance payers, as well as appealing for approvals. 

 

By providing you with the medical criteria you need to make an accurate evaluation based on ASAM and established accepted standards, our staff will help ensure that your clients receive the highest level of care. We work to provide them with the maximum possible benefits, including longer stays and the best treatment options available.

 

Our Utilization Management team can provide recommendations on protocols and programs, and can provide guidelines in implementing clinical forms, paperwork, and processes.

 

 

Benefit, Eligibility & Verification

 

Our team of verification specialists provide you with the most accurate and comprehensive benefit and eligibility information, making the admissions process easier for both you and your clients. 

 

• Complete information on deductibles, co-pays, out-of-pocket maximums and benefit limitationspayment estimates.

• Fast, accurate verification, both electronically and through person-to-person contact.

• 1-hour benefit turnaround.

• Benefits training to help your admissions staff operate smoother and more efficiently

• Complete information on coverage, authorization requirements and any restrictions.

 

Negotiations & Ongoing Agreements

 

 

Negotiations on behalf of the facility for the highest rate of reimbursement for all claims assuring minimal out of pocket patient expenses for out of network services.

Setting up terms for ongoing agreements between your facility and payers to lock in those high rates without contracting agreements.

 

Your Personale Training To help ensure efficiency and proficiency Prime will provide:

 

Staff training on the processes spanning an insurance patient’s admission and discharge.

Detailed training on insurance verification to assure a complete understanding of benefits.

Assistance from PMBS clinical team to help your clinical staff stay current and in compliance with Utilization Criteria for each payer.

 

Insurance Profile and Registration

 

We help you process insurance claims in the most efficient manner possible. Insurance forms to bill insurance companies on behalf of your patients. Register your practice with key insurance companies so you can receive reimbursement as soon as possible. Make arrangement for your practice receive a National Provider Identifier (NPI), as required by Medicare and other payers. Insurances payer ID number, other provider identification numbers as requested.