Healthcare Insurance

RCM.SEHAT provides customized solutions in Healthcare Insurance & RCM based on the client requisites and as per the prevailing market scenario.

• Medical Coding: Our team is consists of certified coders (from both AAPC and AHIMA) who ensure day to day coding compliance is met. Daily review of physician coding is validated and verified prior to finalization of codes.

• AAPC – American Academy of Professional Coders.

• AHIMA – American Health Information Management Association

• Clinical Documentation Improvements: Ensuring the right match of diagnosis to service provided, adds value to the claim and ensures a better payment ratio. Our team of coding experts facilitates doctors to in ensuring the necessary documentation is met to justify the service provided.

• Claims submission: We have centralized coding executives that remotely manage the claims submission for your units. For hospital claims, we would have a dedicated Account executive supervising remote submission process and transactional/ EMR errors delaying the day to day claim process.

• Payment follow-up: We assess the outstanding including the latest monthly submissions and follow a fixed cycle to call and follow up with the relevant payable teams of various insurance companies associated with a healthcare unit. This process allows to keep an approx. track of expected payments within a stipulated time frame (as per contract terms).

• Monthly reconciliation & Sign offs: Once periodical payments are received from insurance companies; our reconciliation executives ensure reconciliation of payments to ensure true current out standings and age trial balance of the healthcare unit is clearly under track. We encourage quarterly and bi-annual sign off of claims to ensure that recovery of claim payments is focused on the current age trial balance.

• Denial Management & Recovery: Once periodical payments are reconciled, emphasis is made on identifying the immediate denials that are can be appealed and re-submitted for a claim. This is carried within stipulated regulatory / insurance frameworks so that the opportunity to maximize the realize-able (from denials) is not missed.


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