How we can help
A practical plan.
A shared understanding.
Professional claims
Physician services are billed as professional claims: the CMS-1500 form, or its electronic version, the 837P. Before a claim goes out, check the patient and insurance details, the link between each procedure and its diagnosis, and the place of service.
Coding that matches the documentation
CPT, ICD-10 and HCPCS codes and their modifiers should reflect what the physician documented, no more and no less. Where the documentation and the codes don’t line up, raise it with the physician rather than guess.
Eligibility before the visit
Confirm active coverage, co-pays, deductibles and any prior authorization the payer requires, so fewer claims come back for reasons that could have been caught at the front desk.
Denials and follow-up
Find out why each denied claim was denied, then correct and resubmit it, or appeal where there are grounds. Track the causes that keep coming back so they can be fixed at the source.
Payment posting
Post payments and adjustments from remittances and explanations of benefits, reconcile them against what was expected, and flag payments that never arrived.
One group, many providers
Each physician in a group is enrolled with payers individually, and claims name both the physician who provided the service and the group billing for it. When providers join or leave, billing and credentialing need to move together.
Start by agreeing on the scope.
We’ll discuss your existing systems, the work your team handles, and the support you want from Highview. Services, access, reporting and commercial terms are agreed before work begins.
Common questions
Good to know
before the call.
How is this different from your medical billing service?
It’s the same claims work, focused on physician practices and groups — professional claims, several providers under one group, and services in the office and at the hospital. Medical billing describes our claims workflow in general.
Do you need patient records to start?
Not for the first call. Records are shared only after a business associate agreement (BAA) is signed and a secure process is agreed. Please don’t send patient information through the website.