Benefit Verifications & Eligibility

With our team of knowledgeable benefit verification specialists, you can be confident that you will receive the most comprehensive and accurate benefit and eligibility information.

All verifications:

•   Are verified both electronically and with a life insurance representative to ensure accuracy
•   Include coverage, authorization requirements, and other coverage restrictions
•   Provide deductible, co-insurance/co-payment, out-of-pocket maximum, and benefits limitations
•   Verifications are completed and returned within 1 hour or less, including after hours and weekends
•   All verifications are cross-referenced with our database for historical comparison of allowable, usual and customary rates, and clinical restrictions

What’s more, our sophisticated software network and skilled team enable us to deliver an in-depth eligibility analysis, giving your company a competitive advantage.

  Utilization Review

Our licensed and experienced clinical staff can help maximize your patients’ benefits by obtaining longer stays at the highest levels of care. With our knowledge and relationships with the various managed care companies we are able to provide you with the medical criteria needed to ensure accurate evaluation of your client based on ASAM and established criteria.

Our utilization review team also examines all aspects of your facility including your mission statement, daily schedule, protocols, and program, and will even assist you in the implementation of the required clinical forms and processes.

At MedPro we take pride in representing your program and in serving as an extension of your company.

  Billing & Collections

Our follow-up on claims is what truly separates MedPro from the competition. MedPro’s expert staff and cutting-edge medical software enable us to deliver the most efficient processing, management, and collection of your accounts. Our services include:

•   Customized electronic claims processing
•   Front-end auditing to ensure error-free claims transmission
•   Filing of secondary and tertiary insurance claims
•   Submission of UB04 and HCFA-1500 claims for both facilities and individual providers
•   Persistent follow-up on all claims
•   Prompt posting of payments
•   Individual patient notes to keep you informed about all outstanding patient accounts
•   Patient billing questions answered personally and efficiently
•   Unparalleled custom weekly and monthly reports
•   Analysis and recommendations for fee structuring
•   Fee negotiations and single case agreements
•   Monthly patient statements
•   Reporting on allowable, usual and customary rates