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Things You Should Know About Submitting Oral Surgery Claims

Dental ClaimsThere are several costly mistakes oral surgeons can make when it comes to submitting oral surgery claims. The billing and coding challenges are unlike any other medical specialty. Apex EDI has the expertise and experience to make processing dental and oral surgery claims easier for you and your staff.

First and foremost, it’s important to know how to capitalize on both the patient’s medical and dental insurance to receive the maximum reimbursement. This requires educating your staff on how to properly request insurance cards, check for benefits and authorize treatment. Your patient’s benefit from lower out of pocket expenses when you make sure everyone on your team understands how to coordinate medical and dental benefits.

It is critical that your billing service has experience in how to properly align dental and medical coding before submitting claims. This can be a daunting task for staff, dentists, and doctors. Having a knowledgeable billing service, like Apex EDI, can relieve this stress and help you eliminate errors. When codes are assigned correctly, it has a direct financial impact on your business. You get reimbursed faster.

Finally, proper documentation must support the claims submitted for reimbursement. Your staff must be able to align and produce the correct medical documents with the procedures billed. The financial risk with incorrect documentation is significant. Insurance companies can recover what they paid to you along with penalties and interest.  

At Apex EDI, we want to ensure that your claims are submitted accurately and you get reimbursed quickly. Mistakes in billing can have a devastating impact on your practice. Contact us at Apex EDI to find out more about how we can help you and request a free demonstration of our software today!

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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.

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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.

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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!

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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.

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