Medilexis specializes in claims consulting to healthcare providers. Our experienced claims consultants will carefully assess every detail of your claim and the insurance carrier's denial in an attempt to determine the most appropriate and effective action to be taken on accounts placed with us. Further, we will research the most recent case and statutory laws, which support payment on your insurance claims.

Overview:
We do pre-collections follow up for claims which have "reject/resubmit" status and have aged beyond 60 - 90 days and are not ready to be assigned to collections. We believe that there is significant value in pursuing these types of claims on behalf of your healthcare facility, particularly in the wake of resource limitations that can prohibit your facility from processing these claims with the same timeliness as the newer claims.
In spite of timely payment rules in many states, a common complaint of all hospitals is difficulty in collecting accounts, which are 60 to 90 days old. Many hospitals have a difficult time reprocessing such claims.

Our goal is to lessen the burden of un-collectible accounts on your facility's financial health.

Benefits:
• An alternative to immediate collection agency placement
• We successfully secure full benefits of claims previously denied
• Provider can maintain good patient/provider relations
• Overall improvement of financial performance, cash flow and profitability

Solution:
Collection of these accounts typically requires:
• Submission of medical or operative records
• Patient completion of coordination of benefits or other forms
• Correction of improper billing information
• Re-submission to the proper carrier

Two-pronged strategy would be adopted:
• To gather denial/rejections details, reasons, etc through follow ups
• To take appropriate actions, i.e. re-filing of claims, etc

1. Follow Ups:
We track denials, log what has been denied, why, how, and when the claim was filed to the greater levels of details.

Keeping in view electronic transactions standards (276/2777) of HIPAA, we will get to the bottom of the claims status, & then will hit the claims accordingly which may include knowing:

• Pre-adjudication (accepted/rejected claim status)

• Claim pended for development (incorrect/incomplete claim(s) within adjudication process) or suspended claim(s) requesting additional information

• Finalized claims. Further defined, finalized claims may have outcomes that include finalized rejected claim(s), finalized denied claim(s), etc.

It should be kept in mind that denials out of medical necessity (mis-coding of claims) will be easy to handle and collect. The denials due to timely filing and incorrect or incomplete information can turn out to be more problematic, especially for claims of a year old or more.

2. Re-filing of Claims:
Reviewing of the reasons for denial, making necessary changes and resubmitting the bills.