Streamlining Your Path to Credentialing Excellence

CREDENTIALING

Payor enrollment involves securing in-network status for medical professionals and facilities, which is crucial for making them billable as soon as possible. With credentialing experts on our team, Astryl Technologies can rapidly enhance your revenue flow with both government and private insurers. Our services include:

• Multi-state contracting

• Delegated credentialing

• Sanction monitoring

• Payor enrollment project work

• Monthly maintenance

• Application submissions for new clinics/providers

• Quarterly CAQH attestations

• Retrieving fee schedules

• Adding practice locations with insurance carriers

• Appealing closed insurance panels

Don’t let the benefits verification process burden your practice

BENEFITS VERIFICATION

A seamless and comprehensive benefits verification solution

At Astryl Technologies, our team of highly skilled revenue management professionals brings years of experience to managing the benefits verification process for our clients, allowing them to focus on delivering exceptional care and long-term health to their patients.

Our benefits verification services include verifying:

• Coverage details and effective dates

• Patient eligibility

• Plan benefits and type

• In-network and out-of-network benefits, along with patient liabilities

• Copayments, coinsurance, and deductibles

• Lifetime maximums

• Out-of-pocket maximums

• Benefits related to provider specialty and specific procedures

• Claims mailing addresses and other payer contact information

• Referral and pre-authorization requirements

Enhancing medical coding to maximize reimbursement collections

CODING

Even with years of experience, it can be challenging for staff to stay current without additional training, especially when meeting the standards set by AAPC and AHIMA for certified coders. Both providers and staff must be proficient in CPT™ and ICD-10 codes, as well as payor guidelines for the services they offer. Astryl Technologies employs highly experienced, credentialed coders (AAPC/AHIMA certified) to provide outsourced medical coding and auditing services, ensuring both revenue optimization and compliance with Medicare, Medicaid, and Tricare standards.

Effective coding requires collaboration. Our training programs can enhance providers’ coding skills.

Astryl Technologies also offers precise and dependable training for providers. Healthcare providers performing evaluation and management services must comply with CMS and AMA’s Evaluation and Management (E/M) guidelines, including the 1995 and 1997 E/M Documentation Guidelines. This involves at least four hours of training annually. Our certified medical coders offer the most valuable training, keeping providers updated with the latest codes and best practices.

Analyzing rejected claims for improvement

Claim rejections are common, but if you notice a recurring pattern or have a denial rate exceeding 10%, it’s crucial to thoroughly investigate the issues. Astryl Technologies provides two effective solutions for a swift assessment of your medical coding strengths and weaknesses:

Enhance your coding team with Astryl Technologies trained professionals.

Our AAPC and AHIMA certified coders can supplement your in-house team, accelerating and improving your medical coding processes. We will also provide feedback on your documentation, compare it to similar practices, and offer recommendations for improvement.

Ensuring Clean Claims, Streamlining Your Revenue Cycle

CLAIM SUBMISSION

Submitting healthcare claims involves several essential steps to ensure timely and accurate reimbursement for providers.

1. Charge Entry Charge entry is the first step where we input details of the services rendered into the billing system. This includes:

   Patient Information: Name, date of birth, and insurance details.

   Service Details: Codes for medical procedures (CPT/HCPCS codes), diagnosis codes (ICD codes), and service quantities.

   Provider Information: National Provider Identifier (NPI), taxonomy codes, and billing address.

   Precision in charge entry is vital, as mistakes at this stage can result in payment delays or denials. The charges must match the documentation in the patient’s medical record to ensure consistency and adherence to payer policies.

2. Claim Edits After charges are entered, claims undergo various edits to detect errors and ensure they meet payer requirements. Claim edits include:

   • Front-End Edits: Conducted during or immediately after charge entry, these edits check for common issues such as missing data fields, incorrect codes, or outdated information. For example, a mismatch between a procedure code and a diagnosis code may trigger a review.

   • Edit and Scrubbing Systems: These advanced systems review claims for compliance with payer guidelines and industry standards. They check for:

     • Code Validity: Confirming that procedure and diagnosis codes are valid and correctly ordered.

     • Modifiers: Ensuring any modifiers used are appropriate and correctly applied.

     • Bundling: Verifying that bundled services are reported accurately and not unbundled unless necessary.

   Claims that clear these edits are then prepared for submission to insurers or government payers.

3. Claim Rejections Post-submission, insurance companies or other payers review claims, and if any issues are found, the claim may be rejected. Common causes for claim rejections include:

   • Incomplete or Incorrect Information: Missing patient data, incorrect codes, or invalid payer identifiers.

   • Coverage Issues: Services might not be covered under the patient’s plan, or preauthorization might be required but not obtained.

   • Policy Violations: Claims may not adhere to specific billing rules or regulations set by the payer.

   When a claim is rejected, the payer usually provides a reason and instructions for correcting the issue. Providers must then review the rejection, make necessary adjustments, and resubmit the claim.

Streamline Your Workflow: Simplify Posting and Correspondence Management with Ease

POSTING AND CORRESPONDENCE MANAGEMENT

• The Electronic Remittance Advice (ERA) is an electronic document that offers comprehensive details about payments made on claims, including any adjustments and denials, serving as the digital counterpart to the traditional Explanation of Benefits (EOB). Typically formatted in a standardized manner such as ANSI X12 835, ERAs are imported automatically into our systems at Astryl Technologies using advanced software or Electronic Health Record (EHR) systems. This automation reduces manual data entry, minimizes errors, and speeds up the payment posting process. We are committed to ensuring that doctors are credentialed to receive automated ERAs to facilitate quicker revenue management and claim closures.

  However, when ERAs are not available—due to delays or because some payers do not send them—paper or electronic EOBs must be handled manually. We obtain these EOBs from various sources, including providers and payers, and verify deposit amounts against bank accounts before posting manually. This involves cross-referencing the EOB amounts with payer records and patient accounts to ensure accuracy. At Astryl Technologies, we meticulously review all correspondence from different sources to fully understand its content, recognizing that it contains crucial information impacting revenue cycle management.

Enhance your RCM operations by partnering with an expert team that caters to your needs

PATIENT PAYMENT AND COLLECTION

When you require extra support to optimize your revenue cycle, you need reliable, high-quality services from a team that seamlessly integrates with your operations. Astryl Technologies brings extensive experience in supporting a diverse range of healthcare clients, including hospitals, health systems, DME suppliers, laboratories, and physician practices. Our approach is collaborative and integrated, which is why we prefer to call it co-sourcing rather than outsourcing.

We treat your business as if it were our own, which is key to our success. We offer a comprehensive suite of RCM services—including credentialing, insurance verification, coding, billing, posting, A/R follow-up, and denials management—delivered by agents working directly from your systems and RCM consultants who align with your business goals. Whether you want to keep certain processes in-house or fully delegate, we can adapt to complement your internal team.

With a focus on transparency, efficiency, and affordability, Astryl Technologies ensures you know exactly where your money goes. Our reasonable pricing and transparent billing practices reflect our commitment to providing value. As you experience improved payments on A/R and fewer denials, you'll find the return on your investment to be substantial.

Enhance your RCM operations by partnering with an expert team that caters to your needs

BUSINESS OFFICE CO-SOURCING

When you require extra support to optimize your revenue cycle, you need reliable, high-quality services from a team that seamlessly integrates with your operations. Astryl Technologies brings extensive experience in supporting a diverse range of healthcare clients, including hospitals, health systems, DME suppliers, laboratories, and physician practices. Our approach is collaborative and integrated, which is why we prefer to call it co-sourcing rather than outsourcing.

We treat your business as if it were our own, which is key to our success. We offer a comprehensive suite of RCM services—including credentialing, insurance verification, coding, billing, posting, A/R follow-up, and denials management—delivered by agents working directly from your systems and RCM consultants who align with your business goals. Whether you want to keep certain processes in-house or fully delegate, we can adapt to complement your internal team.

With a focus on transparency, efficiency, and affordability, Astryl Technologies ensures you know exactly where your money goes. Our reasonable pricing and transparent billing practices reflect our commitment to providing value. As you experience improved payments on A/R and fewer denials, you'll find the return on your investment to be substantial.