Demographics and claim entry

The most important process post patient care is capturing patient data correctly so that a clean claim could be produced for billing.

Often services rendered by providers are complex in nature, payer compliance guidelines and billing rules are dynamic and documenting and billing correctly is a challenging task.

For Claim creation the process starts with Demographics entry and insurance verification. Either through scanning documents to our billing team or having it shipped in packages we collect all the information necessary to generate an encounter: demographics, insurance information, and icd/cpt codes.

Once the information is retrieved the claim can be created using two methods:

  • Manual Claim entry: Claims are created directly into the PM system from a route slip or superbill. Before any claim is generated verification is done for patient's insurance eligibility. At the time of icd/cpt entry various online tools will be used to insure correct coding is done with modifiers, units, and charges.

  • Autogeneration: Claims are automatically created directly from the appointment scheduler. ICD/CPT codes, modifiers, and units are entered into individual patient appointments along with Demographic information and patient insurance details. If any copayments are posted into the appointment details they are directly transferred into the encounter. At the end of the autogeneration process auditing of the newly created claims can still be done before submission. Our skilled and swift staff ensure error free recognition of all parameters and produce correctly coded claims. Our Quality assurance team insists minimum keyboarding errors and we synchronize the correct coding requirements from the insurance companies.
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