CLAIMPOWER INDIA PVT LTD

CLAIMPOWER INDIA PVT LTD. Introduction.

About us:-. Claimpower India Pvt Ltd, formerly known as In-Net India Pvt Ltd, was established in Navi Mumbai on December 1, 2021 On the other hand, the US counterpart is as follows: Claimpower is a family-run healthcare data company based in New Jersey that was founded in 1992. Our main goal is to help independent practices succeed. We concentrate on the financial aspects of healthcare so that doctors can devote more time to mending patients. We develop technologies to save time rather than to create labour . We want to improve the collaboration in healthcare. We are proud to have built all of our own software and an office of over 100 people in India to serve our clients. By off-shoring our operations, we are able to provide a higher level of service to each of our clients at a lower cost. Perhaps, our biggest accomplishment is how many of our clients and employees have stayed with us for over a decade. Our team of experts has unparalleled experience that we'd love to put work for you.

How our process work ?. We receive the records of the patients seen by the Doctor along with the procedures performed, diagnosis analysed , and tests done on the patients, along with their personal and insurance information. All this data is converted into numerical codes and then fed into our application by the Data entry processor. To avoid human errors, we go through the process of Proofreading followed by validation by the analysts. Validation is a process in which the data entered is validated as per the business rules applicable to each Doctor as per their specialties. After final validations, the claims are sent electronically to the insurance companies Online and Paper. The claims that get paid by the insurance companies comes back in the form of EOBs “Explanation of Benefits”. The amount received is posted against the charges billed earlier. The claims that are denied will be reprocessed by Analysts and necessary action will be taken by them to get the claims paid..

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What we have in our process ?. Charge /Accounts Receivable Entry Charge/ Accounts Receivable Validation Medical Coding Charge / Accounts Receivable Proofreading Ageing Appeals Medical Record Auditing Electronic Claim submission Insurance Follow-up Client Support Patient Calls and Bills Clearinghouse Claim Rejection Data Analysis Client Reporting.

Guidelines and Notes-. Some Terms we use: SSN : Social Security Number DOB : Date of Birth DOS : Date of Service DX : Diagnosis PRO : Procedure EOB : Explanation of Benefits.

BATCH : Data Entry date in “YYMMDD (Alphabet)” format Date Format : MMDDYY Name : Last Name, First Name, Middle Initial Multi Link : Set of Procedures under a Single Procedure (E.g.) ECHO: 93307, 93320, 93325 NOS : Not otherwise specified Admin : Administration I.M. : Intramuscular I.V. : Intra Venous.

Super Bills : The record on which the Dr indicates the procedure Tests, Dx analyzed, co-pay received etc. is called a Superbill. DRG : Diagnosis Related Group CPT : Current Procedural Terminology ICD 10 : International Classification of Diseases 10 th Edition H & P : History and Physical COB : Co-Ordination of Benefits HN : Hospital Notes.

PPO : Personal Provider Organization HMO : Health Maintenance Organization PCP : Primary Care Physician NPI : National Provider Identification HCFA : Health Care financing Administration R/O : Ruled Out ROA : Received on Account.

Tx : Treatment E/M : Evaluation and Management Hx : History PA : Physician Assistant HEENT : Head Eyes Ears Nose Throat ENT : Ears Nose Throat NP : Nurse Practitioner F/U : Follow up I & D : Incision and Drainage ROS : Review of System.

PROCEDURE/CPTs. CPT- Procedure code The CPT code is based on the total time of the face to face (floor/unit); encounter is spent with the patient providing counseling or co-ordination of care. The patient is charged as per the length of time of the encounter, or the time spent in counseling or co-ordination of care or in obtaining historical information for patients with communication barriers. Below is the list of all Evaluation and Management CPT codes: Office – Place of service- 01 Hospital – Place of service- 03 and 04 Nursing Home – Place of service- 09 and 10.

E/M CPT codes and levels. Office Levels New Patient Establish Patient Office Consults 2 99202 99212 99241 3 99203 99213 99242 4 99204 99214 99243 5 99205 99215 99244 99245 Hospital Level Hospital Admit Subsequent Hospital care Follow up (f/u) Hospital Consults 1 99221 99231 99251 2 99222 99232 99252 3 99223 99233 99253 4 99254 5 99255 Nursing Levels Nursing Admit Nursing Follow (F/U) Nursing Consults 1 99304 99307 99251 2 99305 99308 99252 3 99306 99309 99253 4 99254 5 99255.

Learn Important Terms. PATIENT:- The person who visits doctor for any kind of counselling, wellness checkup or to get treated for symptoms of an illness is called the Patient. Provider:- Doctor who provides treatment to the patient and charge to their insurance company for p ayment. Payer:- The insurance company who covers patient for any disease or illness and pay to the Doctor when a claim arise. Guarantor/Subscriber:- The person who has the insurance policy is Guarantor/Subscriber. A patient visiting a Doctor may be covered under someone's else policy e.g. a child or spouse under husbands' policy. Practice :- A place where the services are performed. Sometimes it is same as the name of the Doctor e.g. Dr Mark Spencer CLINIC, Pain Management Center of New Jersey etc. Patient Demographic Information :- Some specific information that needs to create a patient account in Doctor’s system. Such as name, sex, address, phone numbers, date of birth and insurance information..

Learn Important Terms. SELF PAY:- When an individual does not have any health insurance and is not covered by either Medicare or Medicaid, he/she is considered to be a “Self Pay” patient. Payment is due at the time of services and payment is made in full at the time of the visit. Patient Payment:- After the insurance pays, the balance that is left becomes the patient responsibility. When the patient pays the balance it is called ‘Patient Payment’. Co-payment:- It is a contract between the insurance company, patient and the Dr. that the patient will be paying the doctor a certain amount during all his visits to the doctor’s office. This copay may range from $ 2 to $ 45. Insurance Payment:- Each claim billed will be first paid by the primary insurance and the balance will be covered by the patients Secondary/Tertiary insurances..

Learn Important Terms. Future Write Off:- When the Dr. does not want the patient to be billed for the balance after the insurance payment, we pass a Future Write Off entry, this is indicated on the Superbill by the doctor as: Do not Bill Insurance Only Waive Copay No Copay No Charge As per AB Accept Insurance When we pass a Future Write Off entry the Validators waive off the balance once the insurance pays. Capitation:- This is the contract between the insurance company, patient & the Dr. that the Dr. will be paid a certain fixed amount of money every month. As per this contract the Dr. will be entitled to receive only the agreed amount. Procedures done exceeding or below the agreed amount will not be considered with the insurance company..

Learn Important Terms. Charity Care:- “Charity Care” means health care services provided to people who are determined to be unable to pay for the cost of health care services. Inability to pay shall be determined through examination of one or more of the following: Individual and family income; Assets; Employment status; Family size; Availability of alternative sources of payment A hospital may determine inability to pay at the time care is rendered or through subsequent efforts to collect sufficient information to make such a determination. Accident Insurance:- Also known as Life Insurance. These insurance policies pay out a sum of money when an accident occurs. The amount paid out depends on the injury, and policy documents with detail amounts paid for different injuries..

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