BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM CARC
🟢 Eligibility Verification and Benefits Check
You Take Care of Your Patients. Let Us Handle the Eligibility Verification and Benefit Check Process
Inconsistencies in eligibility verification and benefits checks will lead to insurance denials, delayed reimbursements, and revenue loss to a practice
Schedule a Call<60s
Response Time
99.9%
Accuracy Rate
500,000+
Verifications Completed
Overview
Why ASP-RCM Solutions is Your Go-To for Eligibility Verification
We take a data-driven approach to eligibility verification that prioritizes efficiency, accuracy, and compliance. Here’s why healthcare providers and patients trust us
Actionable Insights
Our system provides granular details such as CPT code-specific benefits, authorization requirements, and cost-sharing details, enabling informed decisions.
Real-Time Automation
By automating manual verification processes, we minimize errors and reduce turnaround times, enabling instant confirmation of patient eligibility.
Advanced Error Detection
Proprietary algorithms flag discrepancies in payer responses, ensuring you never miss critical coverage details.
Direct Integration with Payers
Our platform connects directly to hundreds of payer databases via EDI (Electronic Data Interchange), ensuring real-time updates on coverage.
Regulatory Compliance
We adhere to HIPAA and other regulatory standards, ensuring secure handling of sensitive patient data while maintaining operational excellence
Operations
A Closer Look at Our Workflow-Driven Verification Process
Our eligibility verification and benefits check process are designed with healthcare providers and RCM professionals in mind. Here's how we achieve operational excellence
Patient Information Capture
Through seamless integration with your EMR/EHR systems, we automatically capture patient demographics and insurance details at the point of scheduling.
Payer System Connectivity
Our platform establishes direct connections with payer systems, ensuring real-time eligibility status for Medicare, Medicaid, and commercial insurers
Coverage and Benefits Extraction
Beyond basic eligibility, we pull data on co-pays, deductibles, out-of-pocket limits, and specific coverage for planned procedures or services.
Validation and Error Reporting
Advanced rule engines validate payer responses, highlighting missing or inaccurate data for proactive resolution
Integration with Pre-Authorization
If a procedure requires prior authorization, our system identifies this need, integrating with pre-authorization workflows to streamline approvals.
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have safely received your patient and encounter data, we code, review, and send claims to payers. We also manage appeals and denials, track payments, and provide frequent updates. Our procedure is designed to be effective and open.
Our qualified coders and billing specialists evaluate every claim stringently. We employ quality control procedures, coding audits, and cross-referencing with payer requirements to guarantee accuracy and lower the possibility of denials.
Our denial management team examines every refused claim to identify the underlying reason. We quickly fix any problems and submit claims again, and where needed, we collaborate with payers on appeals to ensure you get the most money back.
Our pricing policy is adaptable and customized to meet every customer's demands. Usually, we charge a set fee based on volume or a portion of collections. Contact us for a quote tailored to your clinic's particular needs.
Indeed. Our specialty is smooth transfers from internal procedures or other billing businesses. To guarantee that all data is moved safely, our staff will collaborate closely with you and offer training as required.
Resources
Your Go-To Source for Resources, Industry Updates, and Expert Insights
Ready To Get Started
Share your details with us, and we'll set up a tailored demo just for you.
