Explore Our
Credentialing
Services

Discover how our comprehensive credentialing services can simplify the administrative burden of enrolling with insurance payors. We manage every aspect of the credentialing process for both individual providers and group practices, including initial applications, revalidations, and ongoing updates. Our expertise ensures accurate and timely submissions, helping you maintain compliance, expand your patient base, and maximize reimbursement opportunities. Partner with us to streamline credentialing and focus on delivering exceptional care.

Individual and Group Credentialing

We simplify the credentialing process for individual providers and group practices, ensuring timely and accurate enrollment with insurance payors. Our team handles the complexities of applications, renewals, and compliance requirements, helping you maintain uninterrupted access to revenue streams and patient networks.

Insurance Payor Contract Negotiations

Our experts negotiate competitive payor contracts tailored to your practice’s needs. By analyzing reimbursement rates and terms, we secure agreements that optimize your revenue potential while ensuring alignment with your practice’s goals and services.

Electronic Funds Transfer (EFT) and Electronic Remittance Agreement (ERA) Setup

We streamline your financial operations by setting up EFT and ERA services, enabling quick, secure, and efficient payment processing. These systems provide real-time access to remittance data, reducing administrative burdens and improving cash flow management.

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Explore Our Comprehensive Billing and Coding Services

Optimize your practice’s financial performance with our end-to-end billing and coding solutions, including robust cost recovery strategies. We ensure accurate claim submissions, reduce denials, and maximize reimbursements by employing expert coders and leveraging advanced technology. Our comprehensive cost recovery services help identify missed billing opportunities, rectify underpayments, and recover lost revenue, ensuring your practice achieves its full financial potential. From insurance verification and claims management to compliance auditing and revenue cycle optimization, our solutions are designed to simplify complex processes, improve cash flow, and boost your bottom line. Partner with us to streamline your billing operations and focus on delivering exceptional patient care.

Expert Medical Coding Services

Our team of certified medical coders ensures precise and compliant coding for all procedures and diagnoses, minimizing claim denials and enhancing reimbursement accuracy. By staying updated on the latest coding standards and regulations, we help your practice maintain compliance and streamline the billing process, saving time and reducing errors.

Efficient Medical Billing Solutions

Our tailored medical billing services are designed to optimize your revenue cycle and improve cash flow. From claim submissions and payment posting to denial management and patient billing, we handle every aspect of the billing process with accuracy and efficiency, allowing you to focus on patient care.

Comprehensive Cost Recovery

We specialize in uncovering hidden revenue opportunities through detailed audits and analysis. Our cost recovery services identify underpayments, missed billing opportunities, and denied claims to recover lost revenue for your practice. By maximizing reimbursements and streamlining financial processes, we ensure your practice reaches its full financial potential.

Optimize Your Revenue Cycle Today

Join us at Optimum Medical Billing and Credentialing to enhance your billing processes and ensure timely reimbursements. Let us handle the complexities while you focus on patient care.

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Explore Our A/R, Audit and Compliance Services

Maximize your practice’s financial health and ensure regulatory compliance with our Accounts Receivable (A/R), audit, and compliance services. We provide thorough reviews of outstanding claims to accelerate collections and reduce aging balances. Our detailed audits identify discrepancies, improve billing accuracy, and ensure adherence to industry regulations. By proactively managing compliance, we help safeguard your practice from potential risks and penalties, allowing you to focus on delivering high-quality care with confidence.

Accounts Receivable (A/R) Management and Recovery

Our A/R management and recovery services focus on reducing aging balances and improving cash flow by proactively tracking, managing, and recovering outstanding claims. We handle follow-ups with insurance companies and patients, resolve denied or underpaid claims, and ensure timely reimbursements. With our expertise, your practice can achieve a healthier financial standing and fewer disruptions to revenue cycles.

Claims Auditing and Accuracy Verification

Ensure your claims are accurate and compliant with our detailed auditing and verification services. We meticulously review submitted claims for errors, inconsistencies, and non-compliance issues, ensuring correct coding, billing, and documentation. Our audits help minimize denials, increase reimbursement rates, and strengthen your practice’s overall billing processes.

Regulatory Compliance Monitoring and Training

Stay ahead of industry standards with our regulatory compliance services. We monitor your practice’s adherence to healthcare regulations, including HIPAA and payer-specific guidelines, and provide risk assessments to identify potential vulnerabilities. Additionally, we offer tailored staff training to ensure everyone is equipped to maintain compliance, reducing the risk of penalties and safeguarding your practice.

FAQs

Find answers to your most pressing questions about our medical billing services and how we can assist your practice.

What services do you provide?

We provide comprehensive billing and credentialing services designed to optimize the financial and administrative operations of healthcare practices. Our services include medical billing, coding, accounts receivable management, credentialing for individual and group providers, insurance payor contract negotiations, compliance monitoring, claims auditing, cost recovery, and revenue amplification. By managing these critical processes with precision and efficiency, we help healthcare providers focus on patient care while maximizing revenue and maintaining regulatory compliance.

How do you ensure timely reimbursements?

Turnaround times vary by insurance plan. Most major commercial carriers can complete the credentialing and contracting process in 90 – 120 days. Less efficient carriers often take longer than 120 days. Most Medicare contractors are completing provider applications in 60 – 90 days. While we can’t control how long an insurance company takes to process your application, we follow up on all your applications on a regular basis to ensure the process is progressing.

What industries do you serve?

We serve a wide range of industries within the healthcare sector, including (but not limited to) medical practices, behavioral health providers, dental offices, outpatient facilities, physical therapy clinics, and specialized care providers such as chiropractors and speech therapists. Our expertise also extends to group practices, telehealth providers, and allied health professionals, ensuring tailored solutions for diverse healthcare organizations seeking streamlined billing, credentialing, and compliance support.

Can you assist with claim denials?

Yes, we specialize in assisting with claim denials. Our team thoroughly reviews denied claims to identify errors or discrepancies, resolves issues promptly, and resubmits corrected claims to maximize reimbursement. We also analyze denial patterns to implement proactive measures that reduce future denials, ensuring a smoother and more efficient revenue cycle for your practice.

How can I get started?

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Explore OurCredentialing Services