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Claims that go out clean the first time

Accurate billing, fewer denials, and faster payments for general practices. We handle your billing from the first insurance check to the final payment, so your team can focus on patient care.

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Stethoscope and blood pressure monitor on a desk

The problem

Billing is often squeezed into whatever time is left after patient care — claims go out late, denials pile up unanswered, and payments get posted inconsistently. The revenue is there; it's just slow to collect.

Specialties

One billing team, three specialties, each billed its own way.

Every practice needs the same foundation: coverage checked before the visit, accurate coding, claims that go out clean the first time, and follow-up until the payment lands. Mental health, dental and OB-GYN practices each add their own payer rules on top, so we run each one differently.

  1. 01Mental healthTherapy, counselling and psychiatrySee how we bill it
  2. 02Dental healthGeneral and family dentistrySee how we bill it
  3. 03OB-GYNObstetrics and gynecologySee how we bill it
01 · Therapy, counselling and psychiatry

Mental health

Mental health billing runs on recurring sessions, so a small mistake repeats every week. Behavioral-health benefits are often managed by a separate plan, so we confirm who actually covers the session, check visit limits and authorization rules, and log copay or coinsurance terms before the first appointment. Each session is then coded and followed up until it is paid.

  • Behavioral-health benefit checks
  • Visit limits and prior authorization
  • Session and telehealth coding
  • Recurring-claim follow-up
Read the full case study
Proof from our work
eClinicalWorks · Billing alertsPHI removed
eClinicalWorks billing alerts with a logged Cigna OAP copay note; patient details redacted.

Benefit terms written into the patient's billing alerts before the visit, so the front desk collects the right amount.

  1. Plan, copay terms and coverage end date logged
  2. Patient and account balances checked
  3. Billing alert flagged for the front desk
02 · General and family dentistry

Dental health

Dental practices work with two sets of rules: dental plans with annual maximums, frequency limits and waiting periods, and medical plans for treatment that crosses over. We verify both before treatment starts, confirm in-network and out-of-network benefits, and send clean claims, so treatment plans are not held up by surprise denials.

  • Dental and medical coverage checks
  • Annual maximums and frequency limits
  • In- and out-of-network benefits
  • Claims and EOB posting
Read the full case study
Proof from our work
Availity · Verification of benefits
Eligibility and verification of benefits sheet: Availity with Blue Cross Blue Shield, Cigna, UnitedHealthcare, Health Net and Aetna.

Our verification of benefits sheet: eligibility checked through Availity and by phone across the major payers.

  1. Eligibility checked through the Availity portal
  2. Major payers, from Blue Cross Blue Shield to Aetna
  3. Eligibility and benefits confirmed before treatment
03 · Obstetrics and gynecology

OB-GYN

Women's health billing spans many visits per patient: routine gynecology, prenatal care, ultrasounds, delivery and postpartum follow-up, often under global maternity billing. We track every claim across the whole episode, separate what is billed globally from what is billed per visit, secure authorizations for procedures, and keep aging claims moving until they are paid.

  • Global maternity billing
  • Prenatal and ultrasound claims
  • Prior authorization for procedures
  • A/R across the full episode of care
Read the full case study
Proof from our work
eClinicalWorks · Patient inquiryPHI removed
eClinicalWorks patient inquiry: 28 claims, insurance aging buckets and a follow-up panel; identifying details redacted.

One patient account, every claim in view: 28 claims with charges, payments and aging tracked through to follow-up.

  1. 28 claims tracked on one account
  2. Insurance A/R aged from 0–30 to over 90 days
  3. $14,922.23 charged, $6,137.34 paid, the rest worked
  4. Follow-up assigned with priority and status

Across every practice

The daily work behind every claim

Whatever the specialty, two things keep revenue moving: claims watched from the moment they leave the practice, and a front office that never falls behind. Both happen inside your eClinicalWorks setup.

04 · Daily clearinghouse monitoring

Claim tracking

Every day we check the Claim Status dashboard for the files sent through the clearinghouse, such as GatewayEDI or Trizetto. Each file run is reconciled against its batch totals, and total claims are compared with accepted and rejected counts so a failed file is caught straight away. Total, accepted and rejected amounts are audited to prevent billing discrepancies, and exception reports drive the fixes before anything is resubmitted.

  • Clearinghouse file tracking
  • File ID reconciliation
  • Rejection monitoring
  • Amount audits and exception reports
Proof from our work
eClinicalWorks · Claim StatusDetails hidden
eClinicalWorks Claim Status: GatewayEDI files 337, 338 and 339 with 10, 18 and 26 claims, all accepted and none rejected; dates and amounts hidden.

Three GatewayEDI files reconciled: 54 claims sent, 54 accepted, none rejected.

  1. File IDs 337, 338 and 339 checked against batch totals
  2. Total claims per file: 10, 18 and 26
  3. Accepted and rejected counted on every file
  4. Files not yet updated pulled up for review
  5. Exception reports run before resubmission
05 · Front office inside eClinicalWorks

Virtual medical assistant

Our virtual medical assistants work directly in your eClinicalWorks setup alongside your nurse practitioners. They book and reschedule in the scheduler grid, prep charts before visits, route lab results and refill requests, document phone calls, chase prior authorizations and referrals, and check copays and eligibility before the patient arrives.

  • Scheduling in the eCW grid
  • Chart prep for NPs
  • Lab and Rx jellybeans
  • Prior auths and referrals
Proof from our work
eClinicalWorks · Resource schedulerPHI removed
eClinicalWorks resource scheduler for one day across several providers, with lab and prescription queues in the top bar; names and appointment details blurred.

A full clinic day in the eCW scheduler, with the lab, refill and document queues watched alongside.

  1. Appointments booked, cancelled and rescheduled
  2. Lab (L) jellybean: results routed to the NP
  3. Prescription (R) jellybean: refills queued for approval
  4. Each day's schedule reviewed provider by provider

Work samples come from our own billing work.

What's included

Everything it takes to run medical billing properly.

Scope an engagement
01Eligibility verification through payer portals such as Availity and direct calls to insurers
02Verification of Benefits: copays, deductibles, coinsurance, out-of-pocket and network benefits
03Prior authorization requests and payer follow-up
04Clean claim submission to Medicare, Medicaid and commercial payers
05ICD-10-CM, CPT and HCPCS coding review
06Payment posting with EOB review and account reconciliation
07Daily claim status tracking and clearinghouse file reconciliation (e.g. GatewayEDI, Trizetto)
08A/R follow-up on unpaid and aging claims
09Denial management, appeals and denial-pattern tracking
10EOB data entry and clear reporting on verification, claims and payments

Virtual medical assistant

Front-office support, handled remotely

01

Patient scheduling

Book, cancel and reschedule appointments directly in the eCW scheduler grid.

Book a consultation02

Chart prep for NPs

Build new patient records, create progress notes, enter reasons for visit, and update active medical and allergy history.

Book a consultation03

Lab results management

Monitor the Lab (L) jellybean, route incoming results to the NP's inbox, and publish approved results to the patient portal.

Book a consultation04

Outreach & instructions

Call patients with appointment reminders and give specific pre-procedure instructions, such as fasting guidelines.

Book a consultation05

Fax dashboard administration

Sort, index and attach incoming e-faxes to patient charts, and send outbound clinical notes to referring doctors.

Book a consultation06

Telephone encounters

Document patient phone calls, route clinical questions to the NP, and log completed callbacks.

Book a consultation07

Prior authorizations

Submit and track insurance authorizations for medications, imaging (MRI, CT) and procedures through the eCW Prior Auth module.

Book a consultation08

Rx refill requests

Manage the Prescription (R) jellybean, verify patient compliance, and queue refill requests for the NP's approval.

Book a consultation09

healow portal support

Respond to non-clinical patient messages, unlock portal accounts, and help with online check-in issues.

Book a consultation10

Referral management

Create and send outgoing referral letters, attach the required clinical documentation, and track authorization status.

Book a consultation11

Tracking logs

Monitor outstanding lab, diagnostic imaging and referral orders, and follow up on missing reports.

Book a consultation12

Billing prep

Check for missing copays, verify insurance eligibility before appointments, and make sure the NP has marked visit codes before notes are locked.

Book a consultation

Our process

How medical billing engagements run

01

Verify

Coverage, benefits and authorizations checked before each visit to prevent denials up front.

02

Submit

Patient and insurance details reviewed, coding checked, clean claims sent to every payer.

03

Follow up

Unpaid and aging claims chased; every denial corrected at its root cause and appealed.

04

Post & report

Payments posted against EOBs, accounts reconciled, and clear reports on where revenue stands.

Why it matters

What you get from working with us

  1. 01

    Accuracy

    Careful attention to patient details, coding, and payments.

  2. 02

    Prevention

    Coverage and authorizations checked up front to avoid denials.

  3. 03

    Communication

    Clear updates on claims, denials, and payer responses.

  4. 04

    Compliance

    HIPAA-compliant handling of every record, with a signed BAA before we access patient data.

FAQ

Medical Billing questions

General practices, plus three specialties we know well: mental health, dental health and OB-GYN. Most are small and mid-size private practices.

Medicare, Medicaid, and commercial insurance, including Cigna and Blue Shield.

eClinicalWorks (eCW), Epic, Athenahealth, Availity, Healow, and 8x8 — and we adapt quickly to the system your practice already uses.

Every record is handled in a HIPAA-compliant way, and we sign a Business Associate Agreement (BAA) before we access any patient data.

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