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I. Insurance eligibility/benefits verification
Improper eligibility checking is the number one cause for claim rejections. In order to solve the problem dmbi uses a combination of monthly eligibility/capitation lists, online insurance company websites, and automated phone systems to verify if the patient has active or inactive coverage. This includes checking to see if office visit co-pays have been updated, deductibles have been met, or if any specific procedures, such as vaccine administration, are covered.
II.12 Hour Claim Entry
Claims are entered within 12 hours of receiving information regarding the patient's visit. Through the use of high level scanners and file transfer protocols superbills/route slips/encounter forms are received from any doctor's office regardless of practice size and location. Claims are generated for every type of patient care including office, hospital, and nursing home. Intense scrutiny is given to every claim generated and any missing details are requested from the doctor's office before transmission.
III. Clearinghouse report tracking
A significant number of all claims sent electronically (15-20%) are never processed at all due to failed transmission at the clearinghouse level. Dmbi tracks every single claim transmission and verifies its successful submission by using an online tracking utility which receives confirmation and denial status from the clearinghouse and electronic payers. Claims with expired icd/cpt codes and missing demographic information are corrected and resent immediately.