Revenue Integrity & Claims Management
HCM’s Revenue Integrity & Claims Management services are designed to streamline the entire claims process, from credentialing to claim resolution and denial management. By maintaining compliance, optimizing workflows, and leveraging data-driven insights, we help healthcare providers recover the revenue they are owed while minimizing delays and inaccuracies. Our comprehensive solutions focus on reducing denials, resolving claims efficiently, and ensuring financial accuracy, supporting your organization’s financial health and operational success.
Revenue Integrity & Claims Management
CREDENTIALING
Enhancing Provider Enrollment Accuracy
We manage the full credentialing process, ensuring healthcare providers are properly credentialed with payers to prevent delays and denials. Our team oversees payer enrollment, re-credentialing, and compliance management, ensuring accuracy at every step.
- Reduced credentialing-related denials
- Faster claims processing times
- Compliance with payer requirements
CLAIM SUBMISSION
Optimizing Claims for Faster Payments
We ensure accurate claims submission and remittance processing to accelerate cash flow and reduce errors.
- Improved clean claim rates
- Reduced time to payment
- Fewer claims rejections
CLAIM RESOLUTION
Targeted Solutions for Aged Claims
We focus on resolving outstanding claims, starting at 60 days and extending all the way to 365+ days, ensuring no revenue is left behind.
- Increased recovery of aged claims
- Reduced outstanding A/R balances
- Minimized financial loss on overdue claims
DENIAL MANAGEMENT
Turning Challenges into Opportunities
Leveraging decades of payer experience and sophisticated algorithm modeling, our team optimizes denials management to ensure quicker resolutions and higher rates of appeals success. Our focused approach has led to:
- Reduced days in A/R
- Identification of upstream opportunities
- Reduction in cost-to-collect
PAYMENT POSTING
Accurate & Timely Payment Reconciliation
Our team ensures the accurate and timely posting of payments to maintain up-to-date account statuses and reduce errors. We process and reconcile payments efficiently to improve financial clarity and operational transparency.
- Accurate reconciliation of all posted payments
- Timely resolution of payment discrepancies
- Enhanced financial reporting & transparency
CREDIT BALANCE RESOLUTION
Resolving Credit Balances Efficiently
HCM is committed to addressing and resolving all credit balances, regardless of their origin. We thoroughly review and clear outstanding balances, ensuring compliance and maintaining financial integrity for healthcare providers.
- Reduction in outstanding credit balances
- Prevention of compliance risks
- Maintenance of accurate financial records
COMPLEX CLAIMS
Navigating Challenging Claim Scenarios
Our specialized team manages complex claims to ensure proper reimbursement. We handle the intricate details of these claims to reduce the burden on internal staff and ensure timely resolution.
- Focused resolution of motor vehicle accident & workers' compensation claims
- Compliance with legal & payer requirements
- Increased reimbursement for difficult cases
CONTRACT STAFFING
Providing Expert Support for Revenue Cycle Needs
We provide experienced, dedicated staff who are fully integrated into your revenue cycle operations, adapting seamlessly to meet your business office needs through all ebbs and flows. Our staffing solutions ensure consistent support and uninterrupted workflows, precisely aligned with your operational demands.
- Experienced Specialists for essential revenue cycle roles
- Seamless integration with existing teams
- Cost-effective solutions for short-term needs
Enhance Your Financial Operations
SCHEDULE A CONSULTATION
- Discover how Healthcare Chaos Management can transform your revenue integrity and claims management processes for better financial health.
Request a Demo
- See our solutions in action and understand how our advanced technologies can streamline your operations and improve your bottom line.
