The law’s main premise is that a payer must reply to a valid claim within a certain amount of time (usually around 30 days for electronic claims).

In order to efficiently use the clean claim rule, your medical billing process must have a tracking system that flags:

• Which insurance firms are covered by your state’s clean claim statute (some are exempt)?
• The date on which your clinic submits each medical claim for the first time;
• Events that bring the clean claim clock to a halt (e.g., an information request from the payer),
• When your practice has responded to payer requests by taking action;
• The date on which you received the final adjudication decision from the payer.

The prospect of carefully tracking all of this data may seem intimidating, but with the right system architecture, it is both achievable and desirable. Your claims will pay faster after you file a few Clean Claim law violation reports. I’ve witnessed cases when payers have contacted solely to reassure the practitioner that claims will be processed swiftly.

Running a trial on a payer that frequently takes more than 30 days to adjudicate claims is one method to quickly get started using the clean claim law. Find a small number of significant claims for this payer that have been open for more than 30 days and run a test with them. This will enable you to understand the foundations of how to file, monitor, and view the results of complaints.

Tips for Getting Your Medical Practice to Have a 95% Clean Claims Rate

How can your medical practice attain a clean claims rate of 95%? Despite the fact that this may appear to be a tall goal, there are several medical billing tactics your medical practice may apply to help increase your clean claims rate – and your entire revenue cycle management!

Keep patient records up to date.

There’s a lot of patient information that can change—and change quickly—from contact information to insurance carriers and more. Patients must check or update their current information before getting treatment, as faulty patient data is a leading source of denied claims. To reduce delays, use exact documentation to help check patient information ahead of time, and have patients update their paperwork at every visit (or even sooner with automated reminders).

Prior to the date of service, double-check your eligibility.

Patients that come to your office on a regular basis are known as established patients. They’re also the patients who your employees might presume haven’t had any recent insurance changes. Most denied claims, however, are generally the result of outdated established patient insurance information. Collecting and confirming every patient’s primary, secondary, and even tertiary insurance at least five days before their scheduled service is one step toward a 95 percent clean claims rate.

It’s also vital to double-check any in- or out-of-network benefits, copays, or deductibles.

Keep in mind the deadlines for filing insurance claims.

In most cases, filing a claim necessitates submitting it within a specific time frame. Any claim submitted outside of the window will result in a higher number of refused claims.

 If you want your practice to have a near-perfect clean claim ratio, one of the best ways to do so is to pay attention to claim deadlines and handle any concerns with patient coverage prior to their date of service so the claim is not submitted late. Aim for authorization between three and five days prior to service as a best practice.

Even the cleanest, most well-documented claim can often take weeks, if not months, to process. In the meantime, the practice loses out on revenue. This is why many of them opt to have their billing handled by a third party. Ultimately, WWS contributes to a smooth, continuous flow of revenue that benefits the bottom line of health practices. Contact WWS today to learn more.

One of the biggest challenges, which also has a direct impact on the revenue collection of most practices, is credentialing i.e. enrolling with the best insurance service provider. This is not really as simple as it sounds. With so many insurance providers having opened shop, it is not easy to tell which one would be the best for a particular medical practice. No wonder then that most practices prefer to outsource their credentialing services as this would mean one less thing to worry about.

Are you still indecisive about whether to outsource your medical credentialing?

Well, take a look at these pointers which will help you understand when the time is right to outsource your practice’s the credentialing process.

1. Big process

Collecting the necessary details from the patient and other stuffs are a big process which should happen flawlessly. If the billing service staff is employed to collect all these details then it is pretty hard for that single employee to take care of all such things. So it is better to connect with insurance service provider.

2. Lessen your burden

When you take a step forward by implementing software and appoint an insurance provider employee for claiming reimbursement then it becomes an easy task for everybody. Every employee will have his own work to do. The number of workforce will also be increased along with that the technology will also be implemented.

3. Experts on role

If your healthcare industry is less experienced in such insurance stuffs leaving them in experts hand can lead to no denials or rejections of claims. Experts will do their job professionally and minimize the risks of rejections in claims.

Here, you will find our Step-by-Step Physician Credentialing Process

1) Week 1 Strategy and Information Gathering

a) During the first ten days or so after signing an agreement, our team will work with you to massage your payer list and ensure all relevant payers are included.

b) In addition to the payer review, your account manager will work with you to ensure we have everything needed to submit and process your applications.

2) Weeks 2-5 Application Submission & Follow up

a) During this time we will contact all insurance companies and begin the application process.  Some of them require an LOI (letter of interest) and others want you to submit a form on their website.  Regardless of how they do it, we will take care of all of this.

b) Once the requests to join the network have been submitted, this is when the follow-up process starts and continues until everything has been finalized.

3) Weeks 6-9 Follow-Up & Contracting

a) During this period we will continue to follow up and should begin to see your application making it through the payers credentialing process.

b) Once your application has made it through the initial process, we will now ensure it transitions smoothly into the contracting phase.

4) Weeks 10-16 Contract Negotiations & Effective Dates

a) This is when things start to get fun.  Agreements are coming in and you’re beginning to see some results.  Payer agreements are reviewed and submitted to you for signature (if they don’t need to be negotiated).  Once signed, these executed agreements are returned to the payer for loading.  The loading process with some payers can take an additional 30-45 days.

b) Finally, we will work through your payer list and ensure we have effective dates and provider IDs for all applicable payers.  We will then work with you to provide this information to your billing company or department.

EndNotes:

Outsourcing your credentialing is the equivalent of a primary care physician referring to a cardiologist when a patient presents with an irregular heartbeat. While the primary care physician could very likely handle the problem internally, is the risk of missing something serious really worth it? That’s really what you must ask yourself. Based on national credentialing surveys, the average time for a physician to be credentialed by a group is 180 days whereas most of our payers are completed in 90 days.  Is finishing the process faster and more accurately important to you? If it is, we believe you’ll reach the logical conclusion that outsourcing is the answer.

If you have any questions write us @  support@wonderws.com   or Schedule a 30 minute Complimentary live demo on our customized credentialing solutions.