Claims Management

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Plan Benefits Administration

We create benefit categories and load them into our software in accordance with client specifications. In addition, we create benefit plan IDs.

Providers and Contracts

To pay out claims, we create contract classification codes and secure them to contracts. Templates are created for both par and non-par providers. In addition, we download a wide range of fee schedules and modifiers from CMS and conduct ongoing maintenance.

Members Enrollment Administration and Processing

Data scrubbing and member demographics are available through our software. We post daily enrollment files into the CMS and receive and take action on the TRR files. Disenrollment is our specialty as well

Claims Entry and Processing

Both paper and electronic claims entry and processing are options for our clients. In order to correct claims that were not paid appropriately, we conduct claim adjustments. We also process refund requests and work on call center ticket claims. 

Fortunately, we are skilled in HCFA 1500 and UB 92 claims processing and can migrate several insurance processes. We are also experts in working with reports produced by third party claims adjudication systems and can put an end to leakages.

Referral Authorizations

Since most HMOs require patients to obtain a referral from their primary care physician prior to visiting a specialists, we receive and create authorizations for referral requests.

Credentialing

Unlike similar companies, AQKODE Billing offers credentialing. Our team can access the CAQH website and verify the credentials of providers.

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Re-Pricing of UB Claims Via Third Party Portals

IPPS and OPPS methodology claims are priced through our special tool that provides Medicare allowable limits for inpatient and outpatient claims. The tool allows for coding consistency and data quality while reducing compliance risks and editing for NCD or LCD

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Agents Credibility Verifications

Before working during enrollment season, agents must undergo a background check. We conduct thorough checks whenever necessary.

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About Us :

AQKODE Billing made its debut after a team of medical and technical professionals saw the need for support services in the healthcare industry.

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Registered  Office (USA):

1111 Oakfield Dr. Suite 114 Brandon, FL 33511

Registered  Office (India):

Aqkode Healthcare Solutions Pvt. Ltd.
B 1003, The First Commercial Complex, The First Avenue Road, (Off. 132 Road), Vastrapur, Ahmedabad, Gujarat 380015 India

Reach Us :

813-359-8788