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Chiropractic Claims: Chiropractic Care vs. Physical Therapy

Physical Therapy When a patient experiences a bodily injury or physical trauma that requires treatment, they may see a chiropractor and a physical therapist. Apex EDI is familiar with both types of claims. Chiropractors routinely diagnose and treat mechanical disorders of the musculoskeletal system. Physical therapists help restore physical mobility and functioning.

Common chiropractic claims include the diagnosis of medical conditions related to joint pain. Patients often receive a chiropractic adjustment, electrical stimulation, acupuncture or pain management therapy. Sometime a chiropractor will make a referral to a specialty provider to treat ongoing traumatic conditions.  

There are at least twenty different types of techniques used by chiropractors. They include manipulation of the spine and other joints. Chiropractors can usually offer advice related to exercise, nutrition, stress-relief, relaxation, and disease prevention.

chiropractricIn some states a chiropractor may perform minor surgery. They are clinicians who are experts at conservative treatments within their scope of practice. In some states they are considered health care providers. However, they are not medical doctors and do not prescribe medicine.

Physical therapists diagnose musculoskeletal movement. Claims often include techniques such as joint manipulation, gait training, muscle coordination, massage, and cardiovascular rehabilitation. They also have the training to recognize medical conditions and refer patients to specialists as needed.

They often help people who have been in an accident or experience lower back pain, or other physical disabilities. Physical therapy is often combined with other medical practices to restore mobility and help with the rehabilitation of the patient.  

A physical therapist is considered a specialty practitioner by the insurance industry. They are also not a medical doctor and cannot prescribe medication. They use conservative treatments and provide wound care, but do not perform surgery.

Apex EDI is knowledgeable about both chiropractic and physical therapy types of claims. We specialize in medical claims processing and make it easy for you. Contact Apex EDI to request a  today.

Posted in: Chiropractic Claims

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Medical Billing Clearinghouse: What Is a Clearinghouse Service?

Medical Billing Process

can become increasingly complicated as a healthcare practice grows. A clearinghouse service, like Apex EDI, helps eliminate billing errors and ensure claims are paid on time by working as an intermediary between the provider and insurance company.

We check to make sure no errors are made before submitting claims for payment. All procedural and diagnosis codes are checked for validity before being submitted to the insurance company. We also ensure that each procedure code is appropriate for the diagnosis code that accompanies it.  

Another benefit of working with a clearinghouse is that you don’t have to worry about technical compatibility. There are many different billing software systems and the insurance company’s payments systems are not always compatible with them. When needed, Apex EDI can even partner with a number of other clearinghouses to ensure that all claims are processed on a timely basis. This means you receive payment without the worry.  

A clearinghouse takes away the stress of managing the interconnection between software systems, formatting issues, and the ongoing hassle of managing technology issues for you. Every time a medical claim is transferred, there are chances of it being lost, stalled, or denied. We want to minimize those chances for you.  

Apex EDI works with providers and insurance companies to help you avoid the billing headache, eliminate errors, process claims, and receive payment on time. If we can help you get paid sooner without the hassle, it will be well worth the investment. We know we can make a positive impact on your healthcare business. Contact Apex EDI today for a free demonstration of our software.

Posted in: Medical Billing Clearinghouse

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Medical Claims Processing: Tips for Appealing a Denied Medical Claim

Denied Medical ClaimsMedical claims may be denied for a variety of reasons. Fortunately, there are some ways for patients to appeal a denied claim within six months of the healthcare service. Follow these tips and you will have better success recovering denied benefits from your insurance company.  

First, it’s important to understand exactly why the claim was denied. When an insurance company denies a claim they use codes to explain how they arrived at their decision. Look for the explanation of these codes in the explanation of benefits document (EOB) provided by the insurance company. If you need more information, call the insurance provider to ask specific questions.

Then, be sure to provide all missing information to the insurance company. You may need to write a detailed letter that includes your claim and policy number. If the insurance company provides a standard appeal form, be sure to answer all of the questions on the form completely.

If errors were made on the initial claim, provide the documentation needed to make the corrections. This may mean requesting that your provider resubmit information to the insurance company. Even simple, unintended, errors like misspelled names can cause a claim to be denied.

You will need to gather and organize all of the healthcare documentation to show that the services received were medically necessary before submitting an appeal. This includes medical history, prescriptions, referrals, and dates of service.  Apex EDI understands the claims process and the importance of keeping all of the medical information organized.

We work with providers and insurance carriers to minimize mistakes and incorrect denials. Contact Apex EDI for a free demonstration today. We are excited to help you out!

Posted in: Medical Claims Processing

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Claims Processing: How to Avoid Claim Denials

Medical Claims Denial appeals formThe best healthcare practices know that managing claims and avoiding unnecessary claim denials is a crucial part of the business. Errors, oversights, and delays in processing can cause more  than you might think. To have an immediate impact on your business make improvements in these three areas.

All claims must be legible. Even claims printed electronically can get messy, smudged, or blurred from printers and scanners which can create a huge problem for payers. Payers must be able to read and scan claims into their system immediately upon receipt for you to get paid quickly.

Make sure all claims are detailed and specific about the care received by the patient. It’s uncommon for claims missing facts such as the date of the accident, emergency or onset of the medical condition to be denied. It’s important to answer each and every question on a medical claims form.

File all claims in a timely manner. This can get complicated to manage because each insurance carrier operates under its own guidelines and payment schedule. Carriers will deny claims that are simply not received within their payment window stipulated. When you are working with a number of different insurance carriers, you can quickly see the benefit of working with a medical claims processor like Apex EDI.  

Apex EDI works with providers to carefully manage insurance claims and make sure all filing deadlines are met for multiple payers. This allows you to get paid fast and stay focused on providing excellent patient care. Contact us at Apex EDI for a free demonstration today.

Posted in: Claims Processing

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Medical Claims Processing: What Does a Medical Claims Processor Do?

Caring for the health of your patients is the most important part of your business. That is why millions in the healthcare industry rely on specialized professionals, like Apex EDI, to manage the complex interactions between healthcare providers and medical insurance companies. Allowing others to handle this responsibility for you lets you focus your attention where it should be, on the patient.

When a patient seeks medical care, behind the scenes Apex EDI manages the transaction between the provider and the insurance company. We obtain a record of medical services provided from the office, clinic, or hospital and we handle the responsibility of sending healthcare claims out to the patient’s insurance company.

Medical Claims Process can be complicated

The medical claims process is a complicated, yet a crucial component to making sure you get paid accurately and quickly. The knowledgeable staff at Apex EDI understands medical coding, billing terminology, compliance requirements, common errors and the best ways to work with a variety of insurance providers from HMOs, PPOs to Medicare and Medicaid.

We know that payers can deny or reject claims when errors are made. We want to work

with you to help make sure your patient receives the best care possible, receives the insurance coverage they are entitled to, and you get paid in full. There’s nothing more frustrating than dealing with financial payment discrepancies during a health care crisis.  

Working with a medical claims processor can have a positive impact on your healthcare practice and your financial bottom line. Contact Apex EDI to request a free demonstration today.

Posted in: Medical Claims Processing

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