It is extremely important in today’s difficult reimbursement environment that all collectable balances are pursued for payment.  

The system provides statement billing and claims generation on a daily basis. It then produces balance forward statements every 30 days from the original billing date. This evens out the work load and eliminates spikes in incoming patient phone inquires. 

Our system is an open item system where every service has its own balance and detailed history of events that have taken place regarding it.  This level of detail is essential when working the services in insurance follow-up.  If a carrier has paid 5 of the 6 services you can quickly see which one has not been paid and follow-up with the carrier. The insurance follow-up feature helps us better manage claims for services with outstanding balances. We preset the system to "know" when to follow up on a delinquent payer or begin pursuing the next responsible party.  

Medigistics does not let the system automatically re-file any claims. Staff dedicated to insurance follow-up functions works any and all unpaid or denied claims. We strongly believe that the best way for a claim to be filed is to be filed correctly the first time. As described in our proposal our EDX system scrubs and pre-adjudicates services prior to submission to the third party payers. This speeds up claims turn around time and allows our insurance follow-up staff to concentrate on problem payers and services. Insurance follow-up is done on a predetermined schedule that is programmed into the system.

The schedule is as follows

 Commercial Insurance – After 59 days, service balances under $50.00 are released on a statement to the patient. After 59 days, service balances over $50.00 appear on a report and are worked by the insurance follow-up staff. Any denials that are received on EOBs are worked immediately.

Managed Care/HMO – After 59 days, services regardless of the balance appear on a report and are worked by the insurance follow-up staff. Any denials that are received on EOBs are worked immediately.

Medicaid - After 96 days services, regardless of the balance appear on a report and are worked by the insurance follow-up staff. Any denials that are received on EOBs are worked immediately.

  Worker’s Compensation - After 120 days services, regardless of the balance appear on a report and are worked by the insurance follow-up staff. Any denials that are received on EOBs are worked immediately.