The first step in processing a claim is verifying the data contained in the PCR (trip sheet) and supporting documentation.  Essential information sets include incident data, patient name and demographics, patient address and phone number, treatment data, and payor/guarantor identification.  If any are missing such that a claim cannot be processed, associates will turn to a series of Quality Assurance controls.  Controls include:

• Patient data, insurance, and address corrections electronically filtered, sorted, and queued for appropriate billing action
• Non-insured patient demographics are electronically verified against the state-specific Medicaid participant database and other major insurers that offer authentication access to their member databases
• Address scrubber to identify locations that do not exist according to the United States Postal Service
• Contact to facility resource points and/or their healthcare databases to cross-reference digitally archived data
• Direct patient phone calls

Importantly, we maintain data access and sharing agreements with destination facilities and hospitals located throughout our client’s service areas. Establishing cordial, functional relationships with facilities creates digital access to needed patient information, and streamlines the Quality Assurance process.