ProClaims becomes an extension of each of our clients and processes each account according to each individual client’s guidelines: How much is billed; What services are billed for; Are residents and non-residents billed alike; How many invoices will be sent to the patient and will they be turned over to a collection agency? These are all client based, and we will process each claim for each client under these guidelines.
Our goal is to work with the patient on behalf of our client to obtain all information necessary to collect from the patient’s insurance. If the patient has a copay, deductible, or has to pay the entire invoiced amount, ProClaims will work to make this payment process as smooth and easy as possible. We understand the relationship between you and your patients and residents, and we work hard to maintain your fine reputation.
All billing representatives are kept current with Medicare and Medicaid policies and procedures through seminars, newsletters, and information provided on Medicare and Medicaid web sites. ProClaims also retains a nationally recognized Medicare consultant, who, among other provided services, holds on-site reviews to ensure billing practices are current and accurate. In addition, annual meetings can be held at our individual client’s office for a review of their account. General meetings, when warranted, are scheduled at ProClaims’ offices to advise all of our clients of any changes in Medicare and/or Medicaid billing procedures, or for any other mutual needs.
ProClaims complies with all HIPAA rules, regulations and requirements, and all ANSI requirements.
ProClaims will execute a Business Associate Agreement for all clients to maintain compliance with the law.
All claims are filed electronically to Medicare, Medicaid, and any and all major insurance companies that accept electronic filings, which expedites payment. If insurance companies do not accept electronic filings, claims are filed on paper (CMS-1500 forms). Patients without insurance, or those whose trip sheets contain incomplete billing information, will receive invoices in an attempt to gather the needed data, or for payment by the patient.
ProClaims does not negotiate any monies for our clients. All monies collected will be remitted to the client via a third party operated lock box. ProClaims will not have control of any funds received by the client.
ProClaims does not act as a collection agency for our clients. We consider this to be a conflict of interest.
ProClaims will forward all uncollectible bills to the client for its decision on collection action, and will provide any information requested by the client, or their designated collection agency, to make the collection process as easy as possible.
Successful billing begins with ambulance crews trained and educated in proper documentation of run reports. ProClaims will provide initial on-site training, if so requested, for all ambulance crews and supervisors. We are available for ongoing training in addition to both telephone and personal conferences as the needs arise.
No. all costs of set up are included in the monthly charges.
No. All costs are covered in the monthly fee. There are no additional charges for items such as postage, stationary, office supplies or any similar expense.
If you choose to have ProClaims accept credit card payments through our third party provider, on your behalf, a small processing fee will apply. We will be happy to discuss the details with you.
It is ProClaims’ opinion that charging on a percentage of revenue collected basis gives added incentive to do our best for you. Where is the incentive to collect your money, do the extensive follow-up often required, if we have already been paid because we processed a claim? We would rather work harder and collect more funds for you because it is not only better for us, but better for you as well.
Yes, ProClaims follows all of the guidelines required to be compliant with HIPAA (Health Insurance Portability and Accountability Act) rules and regulations, as well as all Federal and State laws.
Yes, if you do not have the necessary Insurance Provider Number, NPI number or any required documentation to collect your funds, we will complete it for you or work with you to get the proper forms and information where it has to be.
ProClaims will come to your offices to train your crews on the proper completion of trip sheets to make the billing process go more smoothly, and to help your staff understand the importance of complete and accurate documentation. If you are using an ePCR program we will work with you to develop “closed call rules” that capture all the information needed for billing before the medic can close out the transport.
Our staff and management attend seminars and training sessions to remain current. Additionally, ProClaims retains the services of a nationally recognized Medicare Billing specialist who reviews our claims on a regular basis for best practices billing procedures.
ProClaims will coordinate with you and your ePCR vendor to set up the most convenient way for to you to transmit data from your ePCR information to us. We can work with any vendor who provides us with the most current NEMSIS formatted file.
