Follow

Claims Submission

Our claims management process is designed to maximize reimbursement efficiency and minimize denials by ensuring every claim is clean, complete, and compliant before submission. Through comprehensive claim scrubbing and validation, we identify and correct errors related to coding, patient demographics, and payer-specific rules. This proactive approach significantly improves first-pass acceptance rates and accelerates the revenue cycle. Claim Scrubbing & Submission
We meticulously review all claims for accuracy and compliance prior to submission, using advanced rules-based engines and payer-specific edits to catch issues that could lead to rejections.
• Seamless integration with clearinghouses and direct payer portals for streamlined claim routing and real-time feedback
• Automated and manual edits to validate critical fields, including NPI (National Provider Identifier), POS (Place of Service), CPT-ICD code linkage, and modifier accuracy
• Support for both batch and real-time electronic claim submissions using industry-standard formats (CMS-1500 for professional claims, UB-04 for institutional claims)

Planning and sketching

Modern and unique design practically point of view, it risks not meeting the huge expectations

Team working

Modern and unique design practically point of view, it risks not meeting the huge expectations

Flowchart and wireframe

Modern and unique design practically point of view, it risks not meeting the huge expectations

User experience Testing

Modern and unique design practically point of view, it risks not meeting the huge expectations

ACA Commercial Risk Adjustment Coding

We support accurate and compliant risk adjustment coding for Affordable Care Act (ACA) exchange-based plans by capturing all eligible diagnoses that impact a member’s Risk Adjustment Factor (RAF) score. Our certified coders conduct thorough medical record reviews and detailed abstraction to identify and document all relevant chronic and high-impact conditions. By aligning with HHS-HCC risk models and payer-specific requirements, we help health plans enhance RAF scores, ensure appropriate premium transfers, and maintain compliance with regulatory standards—ultimately supporting both financial performance and care quality.