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Archive for Medical Claims Processing

Medical Claims Processing: Practice Accelerator™ Part 2

Previously we learned The Practice Accelerator™ is a proprietary process Apex EDI has developed to help healthcare professionals to receive the benefits of clearinghouse services from Apex EDI. This detailed step-by-step process will help office staff understand how Apex EDI will boost the financial performance of your practice.

In this part of the series we will cover phase two of the Practice Accelerator. Steps four through seven make up the second half of the process. These four steps cover your ongoing interactions with Apex EDI—where Apex EDI can make a significant impact on your business.

The PowerTools System™

4Entering the core of The Practice Accelerator™, this step in the process will allow you to interact with our robust set of online tools.

This is the core of what we provide your practice. All the tools available from Apex EDI help you know what is going on in your practice. The PowerTools System helps you create, track, and correct your claims. In addition, we help you better understand how, when, and who will pay for each of your claims.

The TotalCare Program™

5No matter your question or issue, you always have a dedicated team of account managers ready to answer your question.

You have personal, direct connection with a knowledgeable representative you can trust to be ready to help. In fact, your service representative will even call you every few months to check in and make sure your Apex EDI solution is running smoothly.

The Daily Advisor™

6Each day you manage your practice. Our comprehensive tools allow you to monitor your practice.

One of the greatest benefits of The Practice Accelerator is the data you have available at your fingertips. Each and everyday you can access our tools to see where your claims are in the process.

The Cash Delivery™

7The final phase in our revenue management cycle is a constant dedication to providing accurate information to payers to ensure you get paid.

We are dedicated to working to make sure you get paid. We know it is what let's you continue to do the good work you do.

Apex EDI's staff and processes will help you get the most out of your practice. Apex EDI is absolutely committed to providing the fastest, most personal, and most capable customer service and technical support in the electronic claims processing industry. That commitment starts with a unique, personalized approach to customer service you simply won't find anywhere else.

The Practice Accelerator™ will help you better understand how your practice is running and how we can help you improve your practices ability to generate revenue.

About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

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Medical Claims Processing: Practice Accelerator™ Part 1

The Practice Accelerator™ is a proprietary process Apex EDI has developed to help healthcare professionals to receive the benefits of clearinghouse services from Apex EDI. This detailed step-by-step process will help office staff understand how Apex EDI will boost the financial performance of your practice.

In this two part series we will cover the two phases of the Practice Accelerator. Steps one through three make up the first phase of the process. These three phases cover your initial interactions with Apex EDI—as you start your account and we help you set up your connections and get you paid.

The Profile Builder™

1Step one is an installation and customization of our software on your practice computers.

During this step we work closely with your practice to gather the information we need to create your account. We also work directly with the personnel in your office who submit claims to install the Apex EDI software.

The PayerLink Setup™

2During the second step of the process we work with you to enroll you with the payers that reimburse your practice for your claims.

Enrolling with payers can be frustrating and difficult. The Apex EDI enrollment team works closely with your staff and payers to get your practice enrolled and creating the vital link that gets you paid.

The Program Launch™

3After your initial setup we will help to train your staff on how to get the most out of our products.

One of the most valuable services Apex EDI provides to you is the free training we give to your practice. In this step we thoroughly train your practice and get you up and running. In fact we prefer to send a claim during the training process to assure you that everything is operating correctly.

The Practice Accelerator™ will help you better understand where you are in the process of creating your account and how we can help you improve your practices ability to generate revenue.

The next article in this series will cover steps 4-7 and focus on how Apex EDI's staff and processes will help you get the most out of your practice.

About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

Posted in: Medical Claims Processing

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Medical Claims Processing: Your Account Managers Are Your Best Resource

At some point, you may need to contact Apex EDI to ask a question or troubleshoot an issue. One of the major components of our business philosophy is the support we give our clients. Your account manager is your best resource for help getting your claims successfully submitted.

We recently learned that optometry clients had discovered claims were failing after treating post-operative patients. Nothing concerns us more than our providers not getting paid. It is the reason we exist. As soon as we discovered the issue we jumped right in to figure this out and to create a solution.

It was our account management team that discovered the problem and put together a communication to make sure all parties affected learned how to avoid it in the future. Let's take a look at this case study as one way we help resolve your concerns.

Case Study

What to know
There are two dates that must be on a claim in order for the claim to process correctly.

1. The Assumed date is usually the day after surgery and is the date that the office “assumed” care of the patient.
2. The Relinquish date is usually 90 days after the assumed date and is the date that the office ended or “relinquished” care of the patient.

Procedure Dates
Assumed and relinquished dates should normally be 90 days apart exactly. An easy way to do it is to count ahead 13 weeks from the assumed care date and then subtract one day. If surgery was performed on a Wednesday, you look forward 13 Wednesdays from the assumed date and go to the previous day (Tuesday) as your relinquished date.

Claim Format
The proper way to bill post-op claims through Apex is by using box 19, “Reserved for Local Use”. Due to the nature of the electronic claim form, the format in which we receive the post-op data is very crucial. Please use the following template when billing your post op claims.

Post op dd/mm/yyyy to dd/mm/yyyy

For Example
Post op 03/12/2011 to 06/10/2011
The first date is the assumed date and the second is the relinquished date.

Verify Post op Claim Format & Claim Date
Claims can be verified by checking for the assumed and relinquished dates on the claim.

Look for the following segments:

DTP*090*D8*20110325—Assumed date
DTP*091*D8*20110622—Relinquished date

This is just one example of how our highly trained account managers can help you successfully submit claims that get paid. Below are a few more examples of how Apex EDI and our technology and account managers can help.

Reports

Reports from insurance companies provide a status of your claims including claim rejections. In many cases, the rejections provided in the reports Apex provides from insurance companies are the only notice of rejection that you will receive. In addition, reports from insurance companies are generally delivered in 24-48 hours from the time claims are submitted, so the quick response allows you to act quickly to ensure a claim’s payment is not delayed. It is important to know that not all insurance companies provide reports. If the insurance company does not provide electronic status reports, you will receive rejection notices by mail. Apex attempts to make the reports more reader friendly and understandable, but if you ever don’t understand a report, please call your Apex Account Manager for assistance.

Rejection

If you receive a rejection notice from an insurance company and you are not sure why, you should first call the insurance company to get clarification on the rejection reason. If you find the problem is something you can fix, such as an incorrect subscriber ID or birth date, then you need to fix the claim in your practice management software and resubmit it electronically. If the insurance company offers little or no help or their explanation is confusing and leaves you still wondering what to do, you should contact your Apex account manager who will assist you in understanding and fixing the problem.

Account Managers

At Apex we have assigned account managers by region. This allows our account managers to become expert at dealing with the issues that prevent or delay payments of your insurance claims. Also, by assigning an account manager, you have direct access to an account manager that will have maximum availability to assist you. However, any account manager can assist you.

If you ever need any help, please contact your account manager so that we can help you find a way to solve your issue.

About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

Posted in: Medical Claims Processing

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Medical Claims Processing: Life Made Better

At some point in our life we each need a little help. At Apex EDI we have set the goal of making everyone's life we touch to be made better by their association with Apex. It's a lofty goal but we are going for it. Recently we partnered with a local charity to provide meals for children in our community.

Making Lunches

The Food & Care Coalition is a local facility that is dedicated to alleviate hunger and diminish the plights of poverty. Their primary objective is to provide finding suitable housing, teaching financial accountability, facilitating an elevation in personal morals and values, and helping each patron achieve their full potential.

Team Work

Each and every day there is a need for hundreds of meals. Apex EDI worked together to make sack lunches that were primarily distributed to children. Apex administrators Nancy Christiansen and Kim Holliman headed up the effort. They pulled it off with great success. Over the course of three days we packed several hundred lunches that helped ease the plight of the less fortunate in our neighborhoods.

Apex EDI

About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

Posted in: Medical Claims Processing

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Medical Claims Processing: 5 Reasons EHR Helps Practices

Recent healthcare reform provisions will take years to implement, but the HITECH Act and its Meaningful Use provision is quickly beginning to influence greater adoption of Electronic Health Records (EHR).

While Apex EDI does not need to seek Meaningful Use certification many of our partners will and together we play an important role in individual practices achieving Meaningful Use. Many EHR vendors have received Stage 1 Meaningful Use certification and your practice could be on its way to receiving significant incentives.

One of our strengths at Apex EDI is our ability and desire to integrate with a wide variety of practice management software. Our dedication to working with our partners allows us to provide healthcare providers a seamless experience and significant improvement to their practices' operations.

Here are 5 benefits of implementing EHR in a practice.

  • Reduce costs: Record storage, retrieval, and processing costs are a big part of any practice's budget. Moving to an EHR will allow you to streamline scheduling, billing, approvals, referrals, and input of patient information. All of this can lead to reduced staffing or re-allocation of practice staff.
  • Automatically generate and upload regulatory information: Diagnosis codes entered into your practice management software are automatically submitted to the payer.
  • Speed up the billing cycle: Reduced errors and automated insurer adjudication will mean that payments will be returned to your office in a shorter time period.
  • Provide more targeted care: A primary care physician needs specific, reliable information. An EHR will give healthcare providers a detailed medical history that will create better medical care over time.
  • Improve medical research: As EHRs are implemented on a national scale, improved technology will allow for data mining of records by healthcare organizations. This wealth of data should provide greater insight into a variety of issues and illnesses. On a smaller scale individual practice EHRs give doctors valuable information about the health of their practice. With the help of office administrators providers can better manage their business to improve revenue and care to their patients.
About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

Posted in: Medical Claims Processing

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