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End-to-End Medical Billing
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Complete RCM services with AI-driven, payer-specific validation with accurate claim formatting across Montana’s diverse MCOs.
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25–40% reduction in claim rejections and faster reimbursements
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Claims submitted within 24–48 hours
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Eligibility & Benefits Verification
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Multi-stage eligibility checks addressing frequent retroactive changes common in rural, seasonal, and tribal populations
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Reduction in eligibility-related denials by 30–45%
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Instant/ Within 24 hours
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Prior Authorization Management
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Plan-level PA validation for Montana Medicaid MCOs with service-specific documentation alignment
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40–60% reduction in PA-related denials
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3–5 business days
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Coding & Charge Capture
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Assigns ICD-10 and CPT codes aligning with MO HealthNet policy manuals and state edit logics.
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First-pass clean claim rate increases to 95–98%
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Claims filed within 24–48 hours
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Tribal Health & IHS Encounter Billing
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Encounter-based billing workflows, tribal indicator validation, and enhanced rate compliance
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Improved reimbursement accuracy by 20-25%
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Claims processed within 48 hours
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Denial Management
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AI based tools to track and flag denial codes and root-cause analysis tailored for Medicaid claim categories, identifies high-risk categories and automate resubmissions.
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Reduce rate of denial by 75% and with quicker appeals.
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7–14 days for backlog cleanup; ongoing daily follow-up
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Telehealth Billing
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Applies telehealth geography rules, specific codes, modifiers, and POS
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25–40% fewer telehealth denials
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Same-day telehealth claim processing.
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Patient Statements & Follow-Up
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Communicate with patients and give Explanation of Benefits (EOBs).
Includes text/email payment reminders and online payment options.
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Reduces overdue balances and better collection rates.
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1-2 weeks
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Audit & Compliance Support
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Conducts Audit Review and mock audits, including documentation, encounter verification, and claim reconciliation.
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Minimizes risk of penalties and supports successful audits.
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Ongoing, depending on audit schedule
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