Claim Preparation

Simplexmed can assist you in the compilation, calculation, submission and settlement of your insurance claim with insurance companies and medical payers.

Not only does our assistance optimize your entitlement, but it also reduces the time claims normally demand; allowing you to focus on what you do best, running your practice and maintaining relationships with patients.

Healthcare providers prepare insurance claims using information provided in the patient’s bill. Occasionally, the claim is prepared manually and sent by mail. In most cases, the claim is sent electronically (having either been prepared using claim software or scanned from a hard copy) to a clearinghouse. The clearinghouse checks the claim for errors, formats it according to HIPAA and insurance guidelines, then transmits it to the appropriate payer, while also sending a report back to the healthcare provider.

After the claim has been evaluated, the insurer must provide both the patient and healthcare provider with an Explanation of Benefits (EOB). The EOB breaks down the adjudication process, showing the dates of service, procedures and charges, patient financial responsibility, and the amount paid to the healthcare provider. At this point, the health insurer sends payment to the healthcare provider, usually in the form of an electronic fund transfer.

claima prep
Revenue Optimizer (RO)

Revenue Optimizer (RO)

We will optimize your revenue through practice web-portal development and online marketing, payout analysis.

Claim Preparation

Claim Preparation

Error-free claim preparation and validation based on information provided by the practice

Elec/Paper Claim Submission

Elec/Paper Claim Submission

Claims can be submitted either electronically or via paper mail where required

credentialing services

Credentialing Services

When you need essential credentialing data, and you need it immediately, Simplexmed is here to help you

Elec Data Interchange (EDI)

Elec Data Interchange (EDI)

End-to-end encrypted data transfer between payers and providers along with electronic fund transfer (EFT)

Patient Service

Patient Services

Patient calls, itemized electronic and paper statements, and toll-free patient helpdesk

Reporting

Reporting

Get all the relevant reports when you need them. Easy access to all reports with a single click

Coding Services

Provide services in implementation of ICD-10 & CPT codes, help in diagnosis and procedures

Payment Posting

Payment Posting

Faster and accurate claim submission results in timely payment posting to the providers

A/R Management

A/R Management

Timely follow-up with the payers to assure timely payments to the provider

Denial Management

Denial Management

Minimal denials with active web based charge entry system

Meaningful Use

Meaningful use: is using (MU certified) electronic health record (EHR) technology