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Elexoft delivers HIPAA compliant medical billing services to support healthcare practices across the revenue cycle, from insurance verification and medical coding to claim submission, denial handling, patient billing and payment follow up.
Medical billing involves much more than sending a claim to an insurance company.
Before submitting a claim, you must have patient and insurance information on file, confirm coverage, document and code clinical services, and prepare charges correctly. After submission, you must monitor claims for payer responses, payments, rejections, denials, and outstanding balances.
These stages are closely connected.
An eligibility issue identified too late can affect a claim. Incorrect or incomplete coding can require correction. A rejected claim may need attention before it enters payer adjudication. A denial can require documentation, correction, reconsideration or an appeal. A payment may need to be reconciled against the payer's remittance information before you understand the remaining balance.
Our medical billing approach connects these processes into a structured workflow rather than treating each one as an isolated administrative task.
Medical billing works best when every stage has a clear purpose and responsibility. Elexoft's medical billing framework covers the major functions involved in moving healthcare billing information from the patient encounter through claim resolution and payment.
Medical revenue cycle management connects the administrative and financial stages surrounding healthcare reimbursement. It can include patient access activities, insurance verification, coding, charge capture, claims, payment posting, denial management, accounts receivable, and patient billing. Our RCM focused approach looks past individual transactions to understand how one stage affects another and where additional follow up may be required.
Insurance verification helps establish relevant coverage and benefit information before billing progresses. The process may entail confirming active coverage, member information, effective dates, deductibles, copays, coinsurance, network information, and benefits relevant to the planned service. Organized verification gives the practice better information before billing and helps reduce avoidable uncertainty later in the claim lifecycle.
Some services require payer authorization before they are performed or billed. Prior authorization workflows may involve determining whether authorization is required, organizing the requested information, submitting the request, and tracking its status. Authorization requirements vary by payer, plan, and service, so accurate tracking matters. Authorization is also distinct from eligibility: active insurance coverage does not automatically mean a particular service has been authorized.
Medical coding converts documented diagnoses, procedures and services into standardized codes used throughout healthcare billing. Depending on the claim and service, relevant code sets can include ICD-10-CM, CPT and HCPCS. Coding also involves using modifiers appropriately and aligning the submitted codes with the underlying documentation. Accurate coding provides an essential foundation for preparing claims and communicating billed services to payers.
Charge entry connects the documented patient encounter with the information used to prepare a claim. This stage can include patient and provider details, dates of service, place of service, diagnosis codes, procedure codes, modifiers, units, and associated charges. A structured charge entry process helps ensure the billing record reflects the services intended for submission before the claim moves further downstream
Claims processing covers the work required to prepare, review, submit, and monitor medical claims. Prior to submission, claims may be checked for missing or inconsistent information. Electronic claims can then move through a clearinghouse or directly through the applicable submission workflow to the payer. Claims rejected before adjudication may require correction and resubmission. Submitted claims also need status monitoring so unresolved claims don't remain unattended.
A denied claim has been processed by the payer but has not been paid as originally billed, in whole or in part. Denial management commences with understanding the payer's decision. Following steps may include correcting information, providing documentation, resubmitting a corrected claim, requesting reconsideration, or pursuing an appeal when appropriate. Tracking denial reasons also helps identify recurring issues that may originate earlier in the billing process.
Medical accounts receivable management focuses on balances that remain outstanding after billing begins. A/R work may involve aging analysis, claim status review, payer follow up, unresolved claims, underpayments, and other balances requiring action. Separating newer balances from older A/R helps teams prioritize follow up and understand where claims are becoming delayed.
Payment posting records payer and patient payments against the appropriate accounts and claims. Payer remittance information, including electronic remittance advice or an explanation of benefits, can show payments, adjustments, denials and patient responsibility. Accurate posting and reconciliation help ensure that the account reflects what the payer actually adjudicated and identifies balances that still require attention.
Credentialing and provider enrollment support a provider's administrative relationship with medical organizations and payers. Credentialing generally entails verifying and maintaining provider information and qualifications, while payer enrollment covers participation and enrollment processes with health plans or programs. Because requirements vary, these workflows require organized documentation, status tracking, and ongoing maintenance.
Once insurance processing establishes a patient responsibility amount, that balance may move into the patient billing workflow. Patient billing can include statements, account information, payment communication, outstanding balances, and payment follow up. Keeping patient balances distinct from payer A/R makes it easier to understand whether the next action belongs with the insurance payer or the patient.
A medical billing audit reviews selected parts of the billing workflow to find inconsistencies, unresolved issues, or areas that require closer attention. Depending on its scope, the review may examine claims, coding, denials, A/R, payment posting, billing workflows, or reporting. The purpose is not simply to produce another report. It is to understand where billing activities may need correction, stronger controls, or better follow up.
We verify patient, provider, and insurance details to help prevent billing errors and claim issues.
We verify insurance coverage, benefits, and prior authorization requirements before services are provided.
We convert documented diagnoses and services into accurate billing codes and charge information.
We review claims for errors and missing information before submitting them to the appropriate payer.
The payer reviews the submitted claim to determine payment, adjustments, patient responsibility, or denial.
We accurately post payer payments, adjustments, denials and remaining balances to patient accounts.
We follow up on unpaid, underpaid, or denied claims and take appropriate action toward resolution.
We manage patient balances and provide reporting on payments, denials, aging and outstanding claims.
Discover how Elexoft supports your existing workflow, reduces billing workload, and provides clearer visibility into your revenue cycle.
Medical billing requires continuous administrative work after clinical care has been delivered.
Claims need to be prepared and monitored. Payer responses need interpretation. Denials require action. Outstanding balances need follow-up. Payments need to be posted. Patient balances need to be communicated.
For practices with limited internal billing capacity, outsourcing can move some or all of these responsibilities to a dedicated external workflow.
Medical billing requires continuous administrative work after clinical care has been delivered.
Claims need to be prepared and monitored. Payer responses need interpretation. Denials require action. Outstanding balances need follow-up. Payments need to be posted. Patient balances need to be communicated.
For practices with limited internal billing capacity, outsourcing can move some or all of these responsibilities to a dedicated external workflow.
Elexoft supports medical and dental billing as a connected workflow, helping practices manage key billing activities while working with their existing systems and processes.
From insurance verification and coding to claims, denials, and payment follow-up, Elexoft keeps key billing activities connected.
Our billing services work with established practice workflows and software environments, including Kareo, athenahealth, and Epic.
Flexible billing workflows help practices organize revenue cycle activities and adapt as their operational needs grow.
D1050
D0120
D1110
D2330
CPT 41899- ICD-10 S02.5XXA
CPT 41100- ICD-10 C00.9
CPT E0486- ICD-10 G47.33
CPT 21010- ICD-10 M26.60
Medical billing services manage administrative and financial activities involved in turning healthcare services into claims and following those claims through reimbursement. Depending on the scope, services can include insurance verification, coding, charge entry, claim submission, payment posting, denial management, A/R follow-up, and patient billing.
Talk to Elexoft about your medical billing requirements and the parts of your workflow you want to improve or outsource.
