I have worked with almost all specialists of the provider/doctors and following are the process which i have experience
Insurance verification (For commercial and Federal insurances ):
Patient demographics (from patient face-sheet or insurance card):
Charge Entry:
Claims Submission:
Payment posting (Manual and Electronic):
A/R followup( With bucket system):
we will followup with insurance within 10-15 days time span from the date of claim submission , it depends on the how(Media) we have send this claim to insurance(electronic or manual)
Denials Management :
We will work according to denial reason and regarding less of the cause to which it was denied that could be coding denial, billing denial or eligibility of patient.
Authorization for office / Outpatient facilities:
After creating the appointment of the visit we will start sending request to PCP or insurance to get approval this will take place 2 days prior to visit of the service.