Claims Scrubbing

As pediatric coding and documentation experts, PedsOne picks up the charges in the system and conducts an initial review and verification of the information. If the claims are not valid, we offer coding advice and recommendations to providers based on updated coding directives to help correct claim errors before submission.

Processing & Tracking

Once the charges have been scrubbed for accuracy, all claims are submitted electronically, except for those payers who do not accept electronic claim submissions or appealed claims that require additional documentation. We then place a time stamp deadline on each claim and track it to avoid payment processing delays. Claims status is tracked online and in real-time for continued reimbursement management.

Denial Management & Follow-Up

PedsOne reimbursement specialists promptly follow up on claims if payers fail to adjudicate within the specified time frame. Our tracking and management of denied claims helps uncover opportunities in coding and billing practices, resulting in a higher percent of clean claims.

Denial Protocols

Employ an exhaustive and systematic follow up on all missing payments and generate appeals both of which are only limited by payer rules.

  • Assign individual denial codes in order to track trends and increase your collection ratio.
  • Use our well developed relationships with payer to respond directly regarding underpayments
  • Appeal of zero pays
  • Research, analyze and advise practice regarding payer refund requests

Correction Cycle

In turn, PedsOne updates the practice’s internal database to alert providers and staff to changes in payer requirements. We have immediate online access to information requested by payers. This helps expedite claims adjudication with minimal interruption to the practice.

Payment Reconciliation & Posting

Our billing specialists review and reconcile EFT payments and electronic remittance detail every day. Once payment is received into your financial account, we match it to the charge and post it into your account. At the same time, we cross compare contracted, rates allowable schedules and actual payments to spot underpayments.

We follow every claim from submission to adjudication, ensuring proper handling of each submitted claim. Claims submission dates, re-filing, as well as follow-up billing and collection notes are recorded and monitored by the PedsOne billing staff. This process includes protocols such as:

  • Follow up on missing detail necessary for payment posting.
  • Post adjustments and unapplied credits
  • Post any appropriate take backs
  • Review and flag credit balances

Personal AR, Collections

Acting as the main contact for your patients regarding their personal balances, we generate weekly patient bills and monthly statements and make past due reminder phone calls. PedsOne answers patient billing related questions and work in a firm but flexible manner to create customized reasonable payment plans.

As your patient representative, we also:

  • Inform patients about balances after insurance, outstanding co-pays, patient deductions and covered/non-covered services.
  • Create and manage systematic monthly payment plans for appropriate patients.
  • Consult with the practice to implement Credit Card On File payment system.
  • Collaborate with the practice to update patient demographic or coordination of benefits information.
  • Make recommendations to providers regarding transfers to collection agency or bad debt write offs.

Full Service Credentialing

We will conduct enrollment and credentialing for your new providers and confirm the accuracy of your NPI, CAQH and tax id numbers.