TPA Services by Healthgrate
Medical & Insurance Review
Billing
Resubmission Management
Denial Management
Recovery
Reconciliation
Decrease the chances of rejection, deduction and ensure early payment with
Healthgrate TPA.
Medical & Insurance reviews
Medical Billing is the process which is often considered tedious, but is most vital to every provider
Submission of claim as per protocol & as per standardized codes (DRG)
Confirmation receipt of co-payment
Issues or potential errors on agreed tariffs are flagged before submission
Batches of e-claims are submitted quickly & more frequently so as to reduce the billing cycle
Accounts receivable and denials are managed
Every legitimate payer denials identified and corrected for future cycles
Experience seamless communication of data, complete automation of hospitals and patient monitoring systems with Healthgrate.
Reconciliation
Reconciliation of accounts – between what was billed by the provider & paid by payers following all submission & resubmission steps. The main objective is of achieving and maintaining the lowest rejection rate.
Complete analysis of non- or partial payment against submitted claims
Re-process claims with necessary changes and justifications and submit to the payer for re-evaluation
Review the Tariff /Price list and contract terms with payer if rejection is related to the same
Complete review of medical documents and provide medical justification to payers for services claimed
