Payment posting team at Assistwest do not just post payments, they manage all denial eobs. Since the team has knowledge of end-to-end process, payment posting team also calls for the denials immediately after posting the payments instead of waiting for someone to call on these denials from AR calling team with a mindset that every single day is important to save a claim from untimely filing in all aspects. While posting payments following denials are immediately worked on:
• No coverage: eligibility is checked right away to make sure the denial is correct. If denial is correct, eligibility is checked on possible insurance companies which patient may have instead of sending this to client as a question without anymore attempts. If we are unable to obtain insurance info after all attempts, then it will be sent to client as a question/exception. Sending unnecessary questions to client is a crime as per our belief.
• Inclusive/Bundled: If any cpt is denied as inclusive/bundled, a proper modifier is used to get it paid. Payment team has knowledge of all major insurances to bill a corrected claim whether it should be billed electronically or on paper.
• Refund requests or correction/reversal by insurance: Payment team immediately calls insurance companies when they get a refund letter from insurance to check the genuinity of a request and make the client aware.
• No referral: If claim denies for no referral, call is made to confirm the PCP name and info whether the patient can be billed or not.
• Dx/cpt consistency: If claim is denied that cpt and dx is inconsistent with each other (possibly will not deny for this reason as charge entry team does it correctly the first time), CMS website is used by payment posters as well for the correct compatibility of the codes.
There are many more to go with but Assistwest’s strong team will not let such and other denials coming because they take logical steps on every stage of process.