Revenue Cycle Services

Overview Eligibility and Benefits Verification, and Prior Authorization Patient Scheduling Patient Registration Medical Coding Claim Submission & Rejection Management Payment Posting Accounts Receivables Management Denial Management Credit Balance and Refunds Processing Revenue Cycle Analytics Provider Credentialing and Enrollment

The primary reason for claim denials is because a patient is not eligible for services billed to the insurer by the provider. Clarus RCM helps healthcare providers reduce their accounts receivable cycle and increase revenue by reducing denials on account of ineligible patients.

Issues on account of lack of strong eligibility and benefits verification processes:

  1. Reduction in clean claims ratio

  2. Claim denials and consequently rework

  3. Delays in payment from healthcare payers

  4. Reduction in the profitability of the practice

Our eligibility and benefits verification and associated services

We deploy the people, technology and apply our experience to ensure accurate determination of insurance eligibility. Our services include:

  • Receive Patient Schedules from the healthcare provider

  • Verify coverage on all primary and if applicable secondary payers by utilizing payer websites, and IVR systems

  • As required, we make calls to payers to check the eligibility status and patients for additional information

  • Update the results on the practice management system – update member ID, group ID, coverage start and dates, copay information and much more

  • We also provide additional services such as reminding the patient of the POS collection required, obtaining referrals from Primary Care Physicians (PCPs)

Prior Authorization services

Our comprehensive prior authorization services ensure that your patients get timely care while ensuring that you get paid for the services you provide

  • The documentation requirements vary by payer. We prepare prior authorization requests in payer-specific formats

  • We follow-up on submitted requests in a timely manner

  • Update the revenue cycle systems on the status of the prior authorizations

Benefits of our Eligibility and Benefits Verification and Prior Authorization Services

  • Improve speed to care for patients waiting on eligibility verification, particularly for procedures that require prior authorization

  • Improve clean claim submissions

  • Reduce days in A/R

  • Improve collections and profitability

  • Reduce costs by as much as 50% through offshore delivery

connect with us

To learn more about our eligibility and benefits verification, and prior authorization processes, please fill the form and we will be in touch.