BILLING & CLAIMS ADMINISTRATION

Understanding of the Market

Zymeda leadership and staff have worked in the southern California market for over twenty years.  As a result, we understand the complexities and relationships between the regional payors, IPAs, medical groups and health plans and utilize this experience to the benefit of our clients.

Careful Handling of Bills and Claims

The first step in getting insurance companies to pay for services rendered is to submit a complete and accurate bill. That doesn’t sound difficult, but the complexity of the claim coding and submission process generates an unacceptable level of claims returned unpaid.

As your practice billing partner, Zymeda provides a full spectrum of revenue cycle management services, starting with the preparation, validation and submission of solid claims.

As part of our Billing and Claims Administration process, our experienced technicians:

  • Verify patient eligibility and benefits
  • Maximize claim acceptance on first submission
  • Audit and validate coding (manually and electronically) to ensure accuracy and highest level of specificity
  • Maximize electronic (EDI) claims submissions to receive payments 15 days sooner, on average
  • Update fee schedules
  • Perform capitation reconciliation (when applicable)

Coding errors are one of the most common causes of insurance underpayments for physician practices. Zymeda’s coding staff possesses the expertise to code with the greatest degree of specificity, ensuring reimbursement in risk adjusted payment situations.

Our billing service does more than just submit claims; we strive to eliminate claim denials and achieve first submission acceptance by generating “clean claims” that comply with the latest National Government Service policy for Procedure and Diagnosis Coding. Our goal is to minimize the practice’s exposure to coding compliance issues while maximizing revenue. We carefully close the feedback loop between the providers’ and the billing team by actively communicating with providers to educate them about documentation requirements.

Technology You Control

Our EDI system allows our staff and yours to track claims every step of the way from preparation to submission to payment. However, many practices have made significant investments in both technology and staff training with their existing practice management system. Using secure technology, our staff can provide our services using your platform at your facility. You stay in control! Of course, if you are looking to replace or upgrade your current platform, we have options for you to choose from.

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