Filing Claims

  • Claims are submitted to the insurance carrier either electronically or on paper (determined by the carrier).
  • Secondary claims are prepared and sent upon receipt of the primary carrier response.
  • Claims are sent to any carrier that accepts the CMS1500 which is the industry-standard claim form (Commercial, Medicare, Medicaid, Worker’s Compensation, Personal Injury, etc.)

A/R Recovery on Unpaid or Improperly Paid Insurance Claims Billed by PMEB

  • Claims are reviewed for payment approximately 45 days after submission. This allows for insurance processing and mail delays.
  • A/R recovery is achieved through phone calls and re-submissions to the insurance carrier.

Consultation

  • General Advice
  • Offer Suggestions
  • Basic Research

Patient Billing as Directed by the Provider

  • Up to three patient statements are sent to the patient.
  • With no response from the patient the fourth statement is typically returned to the provider and identified as bad debt.
  • Patients that are paying on account balances will continue to receive patient statements until the balance is paid in full

Review Codes and Fees

  • Basic review for minimum Medicare and general carrier allowables versus the provider’s current fee schedule.
  • While reviewing claims to be entered, the PMEB staff will check for appropriate procedure and diagnosis coding. For any discrepancies the provider’s office will be notified. When possible, suggestions will be made for correct coding.