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Health Care Bpo Claim Adjudication Service

Health Care Bpo Claim Adjudication Service

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NextLimit has spearheaded the province of insurance claims outsourcing process. We have been adjudicating medical claims to our clients, implementing the HIPAA complaint systems and captivating them with our resolution of 99 percent plus level of accuracy. Adhering to the CMS guidelines, we keep a stern focus on our project processing timeliness. We feel proud to convey the fact of our executive members being trained in
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Nextlimit Consultancy Services Private Limited

Salt Lake, Kolkata, West Bengal
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Product Description

NextLimit has spearheaded the province of insurance claims outsourcing process. We have been adjudicating medical claims to our clients, implementing the HIPAA complaint systems and captivating them with our resolution of 99 percent plus level of accuracy. Adhering to the CMS guidelines, we keep a stern focus on our project processing timeliness. We feel proud to convey the fact of our executive members being trained in several industry- claims adjudication software and can adapt to any claims- adjudication system within a short period.

HIGHLIGHTS

  • Discerning member eligibility criteria
  • Verifying all imputed parameters in case of un-electronically filed claims
  • Primary insurance verification
  • Determination of timely filing limit of claims
  • Confirmation of provider status (participating / non-participating)
  • Checking authorization notes for instructions and applying authorization status to claims
  • Identification of duplicate / corrected / interim / final submissions
  • Determination of DRG
  • Apply case-rate / per diem to services within the purview of the case-rate / per diem contract
  • Determination of correct allowable
  • Ensuring that co-pay, coinsurance, deductible and OOP are accurate
  • Calculated and applied as per the benefit plan
  • Use of appropriate remark & adjustment codes
  • Real time audits
  • Customized reporting:-
  • Inventory report
  • Quality report
  • Production report
  • Pend report
  • Skip report
CREDENTIALING

At NextLimit, we feel euphoric for prospering our clients with a complete range of credentialing services through a time-tested technique.

Did you know that proper credentialing requires a watchful eye for total and stringent compliance with applicable standards? It also requires the proper evaluation of applicants with respect to their competencies. For this, a number of resources are consulted such as the social, academic and professional history of the applicant, peer and expert reviews, end-user reviews on the quality of the applicant’s services, and more.

At NextLimit, we are fully equipped to take care of all these requirements quickly and efficiently. We approach the subject in an organized and systematic manner. The key steps in our credentialing process are as follows:

HIGHLIGHTS

  • Full range of credentialing services
  • Re-credentialing after every 3 years
  • Regular update of provider’s data in credentialing and claims systems
  • Generation of all pertinent reports :-
  • HSD report
  • Physician and Facility reports
  • Weekly Add/Term report
  • Delegated credentialing report
  • Group/taxonomy etc.
  • Specific Ad-Hoc reports
  • At NextLimit, we work with a troupe of credentialing experts who strictly abide by the standards and guidelines entailed within the Medicare Managed Care Manual (MMCM) and National Committee for Quality Assurance (NCQA).


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Health Care Bpo Claim Adjudication Service

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About the Company

Legal Status of FirmLimited Company (Ltd./Pvt.Ltd.)
Nature of BusinessService Provider
IndiaMART Member SinceJul 2017
GST19AAFCN4800K1ZC
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Seller Contact Details

Soumya Ranjan Nayak

Ps Srijan Corporate Park, Gp Block, Sector V
Salt Lake
Kolkata - 700091, West Bengal, India

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