DMBI uses a batch system in order to prevent the problems of over-posting and under-posting payments from the insurance companies. All EOB batch totals are matched with the billing system's own payment report at the time of posting. This guarantees that any amount posted in the doctor's system matches “penny to penny” the checks cashed by the physician. Any amounts due to the physician from uncollected deductibles, co-pays, and coinsurance are eventually noted on patient statements which are promptly mailed out.
All denied claims are identified directly from the EOBs and duly tagged according to the reason for their denial.
In essence all denials are extrapolated from the other outstanding claims in the system in order to take a directed approach in resolving them.
A dedicated team is set aside to fix all denials and resend them prior to their timely filing limit. In addition all denied claims requiring telephone correspondence with patients are done with an evening customer service team. Proactive efforts are taken to resolve claim denials to prevent sending patient statements which are routinely ignored and or discarded.
Once claims are sent to the insurance company a process of analyzing their payment status is begun.
Through the use of insurance company website and automated phone systems all claims are noted as either being denied, capitated, not on file, or set to pay in the billing program. By analyzing outstanding claims all claims which are not on file are quickly identified and resent in a three fold manner: electronic re-submission through the billing system and websites, HCFA-1500 mailing, and fax to insurance companies directly.