Is there a Dr in the house? Or Medical office mgr???

[Kento-Moto]

Really, no kiddin.

The Company I work for sells business services and is offering a new medical claims adjudication service and I want to know if this would be a big hit or not... I really want your opinion and this is not a sales pitch, but if you have questions or comments or want more info you can comment here or pm me.

Home | A-Claim

Thanks

 

[99'busa]

They call me Dr. LOOOVE

Does that count

sorry but a free bump

 

[Mr Bogus]

Really, no kiddin.

The Company I work for sells business services and is offering a new medical claims adjudication service and I want to know if this would be a big hit or not... I really want your opinion and this is not a sales pitch, but if you have questions or comments or want more info you can comment here or pm me.

Home | A-Claim

Thanks

what would you like to know? Most of the service charge a flat rate for XX number of claims and then a $ for every claim after that.. any claim the drops to paper is an extra charge...

Getting an office to switch? Good luck.. the migration is nothing but a big stressful headache.. it can take 50 to 100 days to find out something is wrong and get it fixed.. turns into 6 or 7 figures worth of claims...

I use MDOn-line, emdeon and direct submission for Medicare.. I hate them all... (you also have to deal with ERA returns and the setup there... it all boils down to if it is working, you do not dare fool with it)

 

[Kento-Moto]

Randy, thanks for the comments and there is alot of the details I am unfamiliar with. Basically A-Claim is supposed to be changing the medical insurance application into an electronic transaction similar to a credit card transaction. I am told there is no identical service to this, the parent company is Blue Cross / Blue Shield and is sponsored by VISA so there are some sizable players making this happen. They say they are reducing time with instant eligibility and with Tri-Care and eventually others, the claim gets filed instantly thus getting the Dr. / Clinic / practice settled quicker. But the bigger and more important hope is that Dr.'s have less uncollectable debt from patients. I know I just got a bill for my portion from my dentist services in May, I think I would rather have paid it in May. ???

 

[motogp08]

They call me Dr. LOOOVE

Does that count

sorry but a free bump

Oh dear goodness, someone return that one to his padded cell! :eh:

 

[SAMBUSA]

They call me Dr. LOOOVE

Does that count

sorry but a free bump

Fall asleep at the keyboard again? That's really cool that you can type while you're dreaming.

 

[Mrs.Rubber2Burn]

I work for a managed care company. I can tell you that a lot of the bigger group practices submit electronic claims either directly or through electronic claims "clearing houses" such as payer path. Some of the solo practitioners or onsie - twosies as we call them still bill two old fashioned way by mailing in the HCFA-1500. Of course our facilities bill on the UB-04.

If you need more info from my side of it, let me know. I will tell you that I work in contract negotiations, and when I negotiate with facility's and providers it will come down to pulling teeth as to which codes (be it CPT, Rev, or HCPC) that we will contract/pay at. Then after contract is executed if they bill claims one way and we are set up another, getting their office to change their billing process is a nightmare and requires MONTHS of claims adjustments.

 

[Scar]

Hmm... ??? It's all greek to me...

Good luck, Kent.

 

[Kento-Moto]

I work for a managed care company. I can tell you that a lot of the bigger group practices submit electronic claims either directly or through electronic claims "clearing houses" such as payer path. Some of the solo practitioners or onsie - twosies as we call them still bill two old fashioned way by mailing in the HCFA-1500. Of course our facilities bill on the UB-04.

If you need more info from my side of it, let me know. I will tell you that I work in contract negotiations, and when I negotiate with facility's and providers it will come down to pulling teeth as to which codes (be it CPT, Rev, or HCPC) that we will contract/pay at. Then after contract is executed if they bill claims one way and we are set up another, getting their office to change their billing process is a nightmare and requires MONTHS of claims adjustments.

Thanks Kristin, and yes I will send you an email with a few more questions. - Kent

 

[Mr Bogus]

Randy, thanks for the comments and there is alot of the details I am unfamiliar with. Basically A-Claim is supposed to be changing the medical insurance application into an electronic transaction similar to a credit card transaction. I am told there is no identical service to this, the parent company is Blue Cross / Blue Shield and is sponsored by VISA so there are some sizable players making this happen. They say they are reducing time with instant eligibility and with Tri-Care and eventually others, the claim gets filed instantly thus getting the Dr. / Clinic / practice settled quicker. But the bigger and more important hope is that Dr.'s have less uncollectable debt from patients. I know I just got a bill for my portion from my dentist services in May, I think I would rather have paid it in May. ???

our claims go in daily via a formatted text file (HCFA1500 format)

They go in via our processor that separates the "payors" as well as the "electronic capable" and the "paper only" payors.. We submit direct to BC/BS via their dedicated system via AIM.. They then send us ERA's so that our system can post payments, deductions and writeoffs... (these systems still lack a lot on "notes" and documentation to the patient)

We also do contract negotiation on our own behalf. As we do IVE infusions it is pretty high dollar stuff (an IVE patient comes in every 2-4 weeks at $5000 to $10,000 per visit, this is a lifetime routine)...

I think the biggest headache is the patient... they get an EOB well before we do and with much better detail.. then they call us wanting information that they already have...

 

[Kento-Moto]

I understand most of what your saying, but how long does it take for the claim to be settled and paid?

 

[Kento-Moto]

:bump: No Doctors here ???