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Services We Provide

Crystal Billing Services

CBS acquires complete patient benefit information, starts any pre-authorization required (with previously provided documentation), files claims once all is approved, and files appropriate claim appeals if necessary.

Please click on each service to view what the CBS team will provide you and your practice, as a client of CBS.

Click the headers below to expand and learn more.

BENEFIT QUOTE

What is a Benefit Quote:
the contractual payout agreed to by the carrier for the policy holder. (Reference link)

What CBS provides:
CBS will contact patients’ insurance company to verify benefits; In and Out of network deductibles (INN, OON), Out of Pocket maximums (OOP), Coinsurance, and Copays, and inform your office of the information. Our team will also verify what Authorizations are required, and take the necessary steps to obtain the authorizations (there are penalties for not taking these steps precisely with the correct information). If allowed, abiding by the individual insurance guidelines and patients’ policy, we will find out the steps necessary to request an in-network exception (GAP).

PRE-AUTHORIZATIONS, PRE-NOTIFICATIONS, PRE-CERTIFICATION, AND PRE- DETERMINATIONS

What is an Insurance Authorization:
a nursing intervention from the Nursing Interventions Classification (NIC) defined as assisting the patient and provider to secure payment for health services or equipment from a third party. (Reference link)

What CBS provides:
CBS will contact member’s insurance company to initiate the correct type of authorization recommended by the benefits department. We send in supporting documentation requested by the insurance company and check the status of the authorizations until it is either approved or denied. All authorizations have to be proven as Medically Necessary.

GAP/INN EXCEPTION

What is a GAP/INN Exception:
If granted and agreed with your insurance company, you will be billed for the medical treatment, surgery, or services as if they are in network. (Reference link)

What CBS provides:
Sometimes, depending on each plan there may be a process allowing patient to gain access to their higher level of benefits with a non-participating provider. CBS will inform our offices of the process patients’ plan requires in obtaining a GAP. If a GAP is initiated, we will check the status until it is approved or denied. Some GAP/INN exceptions have to be proven as Medically Necessary.

MEDICAL CLAIMS FILING, PROCESSING, AND FOLLOW-UP

What is a medical claim:
an itemized statement of services and costs from a health care provider or facility submitted to the insured for payment. (Reference link)

What CBS provides:
CBS will follow the processing of every claim filed for your practice. Our team has been trained to identify and address any/all issues that may arise during the processing of your claims. If a claim is processed incorrectly, our team will work endlessly to have the claim reviewed and reprocessed correctly. It is not uncommon for Insurance companies to take more than 30-45 business days for processing medical claims for dentists, we follow these claims all the way through no matter how small or how long.

CLAIM APPEAL

What is a claim appeal:
In health care accounting, denotes a request from a physician or clerical worker in a health care facility for a third-party payer to reconsider a decision about a disallowed claim for compensation. (Reference link)

What CBS provides:
If a claim has been denied for inaccurate reasons that can be proven false with correct documentation, CBS will take the necessary steps for initiating the claim appeals process; this is to ensure that all avenues available were taken to process your claim.

We are not just fighting for our offices but also for the patients so that they are getting their maximum reimbursement as per their plan. Please contact us for pricing.
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