ABA practices frequently get stuck if they repeat the same traditional claim submissions formula. Consistency lends providers a false sense of security. However, this stagnation can lead to loss of revenue through failure to adopt superior filing methods. So, flexible ABA agencies must review the pros and cons of alternative claim submission procedures.
Practices use traditional physical mail to submit paper documents directly to an insurer’s office. In such cases, savvy billers opt for certified mail to ensure timely receipt. Additionally, tracking of such mail is popular with medical billers who wish to know their submission’s current location and status constantly.
In-office staff sometimes fail to attach necessary documents to physical submissions. They go wrong with reviewing and including the insurer’s required materials, such as a primary EOB or Medical Records.
Snail mail claims are the least time-efficient submission method. The system’s slow pace delays the collection process. Additionally, physical submissions are more likely to disappear than digital ones. Only use snail mail when the Payer offers no other alternative.
Online submissions typically occur through the insurer’s portal. The site will inform billers of formatting requirements. Since most insurers have claim portals, they’ve become the preferred option for do-it-yourself practices.
Because of some portals’ visual homogeneity, billers may erroneously assume Payers have similar standards. Additionally, formatting mistakes sometimes occur due to identical labeling. The following superficially similar formats have critical differences:
● 837p: Healthcare professional providers and suppliers use the standard format to send health care claims electronically.
● 837i: The standard format institutional providers use to transmit health care claims electronically.
Those ABA agencies that need an additional review may benefit from using a clearinghouse. Practices submit claims to the clearinghouse through a PMS or billing system. These systems allow the two organizations to network before a claim reaches the insurer.
The clearinghouse will review and scrub the claim before transferring it to the payer. If an insurer rejects a claim, they may send it back through the intermediary. The clearinghouse will charge a set fee regardless of a claim being paid or denied.
Third-party billing services handle the filing process for practices. These organizations take patient notes, turn them into claims, and submit them to payers. Because of professional billers’ experience, they rarely release any claims that have errors.
When partnering with a third-party billing service, ABA practices must review several key factors:
● Exact Role: Clearly define what tasks the billing service will undertake and what information they need from you.
● KPI Map: Establish KPI targets and request regular reports regarding progression towards these goals.
● Equipment: Professional billers should have automatic systems to boost the accuracy of the submission process.
Plutus Health scores highly on these features, providing a stable business foundation. We’ve consistently produced accurate claims and timely submissions. This steadfast quality has earned us a satisfied and growing customer base of ABA practices. Contact us to begin your professional claim submissions transition.
1. Verified snail mail is sometimes necessary when submitting to outdated insurers.
2. Online portals offer instant, payer-specific submission sites.
3. Clearinghouses will review claims before sending them to the insurer.
4. Professional billing services take patient notes and turn them into accurate submissions.
Balaji Ramani has more than 20+ years of experience in Healthcare Revenue Cycle Management. Balaji has expertise in building, training, mentoring, and managing end-to-end healthcare RCM teams. He has experience using the Web for information sourcing, research & analyses to enable ‘patient and payer satisfaction’ in the healthcare space.
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