Insurance claims and medical BPO
Fewer denials, and every claim followed through.
From eligibility checks to appeals, a dedicated claims team works your payer queue every day, so money you have earned does not sit in accounts receivable or slip past a filing deadline.
- Scope
- Medical and HMO claims
- Follow-up
- Every open claim
- Compliance
- HIPAA trained
- Lower back-office costs
- 35%+
- Dedicated coverage
- 24/7
- Talent retained
- 100%
01Overview
Claims handled from start to paid.
Revenue, not paperwork. Claims fail on small things: a lapsed policy, a missing modifier, a deadline nobody tracked. Your dedicated team checks before it submits and chases until it is paid, working inside your billing software and payer portals.
Built for
- Physician practices and medical groups
- HMOs and managed care organisations
- Billing companies that need more hands
- Ambulatory and specialty centres
- Insurance administrators
02What is included
What your team works every day
Take on one part of the claim cycle or all of it. Your team follows your payer rules and your sign-off limits.
Eligibility and benefits checks
Coverage confirmed before the visit, so patients and staff know what is covered and claims start clean.
Prior authorisations
Requests prepared and submitted with the right documents, then tracked until a decision comes back.
Claim entry and submission
Charges entered and claims scrubbed for errors before they go to the clearinghouse or payer.
HMO claims processing
Specialised handling of HMO and capitated claims, encounter data and referral requirements.
Status follow-up
Unpaid claims worked by age and value, through payer portals and calls, until each one is resolved.
Denials and appeals
Denials sorted by cause, corrected and resubmitted, with appeal letters drafted for your review.
03How it works
How a claim moves through your team
Verify
Eligibility, benefits and authorisation are confirmed before the claim is built.
Submit clean
Claims are checked against payer rules and sent the same way every time.
Follow-up
Open claims are worked on a schedule, oldest and largest first.
Resolve
Denials are fixed or appealed, and the root cause is reported back to you.
04Outcomes
What changes for your revenue
Faster payment
Clean first submissions and steady follow-up shorten the time between visit and payment.
Fewer write-offs
Claims are chased before filing and appeal deadlines pass, so less revenue is lost for good.
Clear view of your AR
Regular reporting shows what is open, why it is stuck and what your team is doing about it.
- Dedicated to you, never shared
- HIPAA trained before day one
- Badge access secured offices
- Managed from Pasadena, California
05FAQ
Questions about this service
Something else on your mind? Schedule a call and we'll walk you through it.
Do you work in our billing system?
Yes. Your team logs into your practice management or billing software, clearinghouse and payer portals with accounts you set up, so your data stays in your systems.
Can you work only part of the claim cycle?
Yes. Some clients hand over just follow-up and denials, others the whole cycle. We size the team to the work you choose.
Do you handle HMO and managed care claims?
Yes. HMO claims processing is one of our specialised services, including encounter data, referrals and capitation-related work.
Who has the final say on appeals and adjustments?
You do. Your team works within the approval limits you set and escalates anything outside them to your staff.
06More services
Pair it with another service
One dedicated team can cover several services. Mix what you need and scale when you are ready.
- Customer carephone, chat, emailA voice your customers recognise, on every shift.
- Data entryrecords, intake, EHRClean records, entered once and entered right.
- Renewal managementpolicies, contractsNo renewal slips through the cracks.
- Billinginvoicing, collectionsInvoices out on time, collections chased up.
- Surveys and feedbackpatients, customersHear what people really think, and act on it.
- Dashboards and reportingKPIs, dashboards, reportsYour numbers current, your reports on time.
- Business intelligenceanalysis, forecasts, insightsThe why behind your numbers, and what to do next.