Billing and Claims Administration

Billing and claims administration: we fired the robots.

Zymeda leadership and staff have worked in healthcare markets across the U.S for over twenty years. We understand the complexities and relationships between the regional payors, IPAs, medical groups and health plans — and we know technology is a tool, not the total solution.  

Careful handling — sounds simple, but what in healthcare is simple? 

The first step in getting insurance companies to pay for services rendered is to submit a complete and accurate bill. Claim coding is complex, and the submission process can generate an unacceptable level of returned, unpaid claims.

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. Our experienced technicians will:

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

The Zymeda EDI system — 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. Of course, if you are looking to replace or upgrade your current platform, we have options.

Robots submit. Zymeda communicates.

Coding errors are one of the most common causes of insurance underpayments. Zymeda’s coding staff are people, not just programs. Together, we have 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” — claims that comply with the latest National Government Service policy for Procedure and Diagnosis Coding.

Our goal: minimize compliance issues while maximizing revenue.

We carefully close the feedback loop between the providers and the billing team with active communication — educating providers about documentation requirements. It’s another goal that may sound simple, but it’s not. We just make it feel that way.

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