Whether you run a small clinic or a large hospital system, we manage claims accurately and efficiently so your revenue stays strong and predictable.
Before every visit, we confirm active coverage, plan type, deductible status, copay responsibility, and prior authorization requirements. We verify commercial plans through Horizon Blue Cross Blue Shield of New Jersey.
Certified coders assign ICD-10, CPT, and HCPCS codes with precision and provide full documentation review. We follow Horizon bundling logic, NJ FamilyCare specialty policies, and current CMS updates to ensure compliance and accuracy.
We verify NPI linkages, modifier sequencing, place-of-service codes, and payer-specific formatting requirements. Claims submitted electronically are tracked through adjudication until payment posts.
We submit complete clinical documentation, monitor approval status, correctly attach authorization numbers, and manage renewals.
Every denial is reviewed within 48 hours to determine the exact root cause. We correct coding, eligibility, or documentation gaps and file structured appeals with full supporting records
We actively manage 30-, 60-, 90-, and 120-day aging buckets with disciplined follow-up. High-value and time-sensitive claims receive immediate priority to protect filing deadlines.
We manage credentialing with Horizon Blue Cross Blue Shield of New Jersey, Amerigroup New Jersey, UnitedHealthcare Community Plan, and NJ FamilyCare. Commercial carrier enrollment across the state is monitored for status accuracy and renewal cycles.
Every county, every MCO, every claim submitted right.
New Jersey is densely populated and tightly regulated. That translates into high billing volume and high denial risk.
Horizon Blue Cross Blue Shield of New Jersey alone covers close to 1.6 million members. Their authorization requirements update quarterly. Their modifier logic differs from standard CMS rules in several specialties. Submitting a claim with outdated formatting can delay payment for weeks.
NJ FamilyCare runs Medicaid and CHIP through multiple managed care organizations. Patients switch MCOs. Providers often are not notified. Billing the wrong MCO results in an automatic denial.
Simple process. Measurable gains. Zero guesswork.
We review your claims over the last 90 days and measure denial rates, AR aging, payer mix, and coding accuracy
Epic, athenahealth, eClinicalWorks, Kareo, AdvancedMD, Greenway Health. Go live in 5–7 business days.
Charges are submitted daily after structured scrubbing for Horizon policy edits, NJ FamilyCare MCO verification, and Medicare compliance
Every denial receives a root cause review. Appeals are written in payer-specific language and supported by documentation that meets policy standards. Aging claims are prioritized before the timely filing window closes.
Your dedicated account manager reviews performance metrics with you each month. We discuss denial trends, payer behavior shifts, and regulatory updates impacting New Jersey providers.
Our team handles every detail so your claims go out clean, get paid faster, and AR stays under control. We bill all major New Jersey payers every day, ensuring no revenue is left behind.
Our billing team adapts to your existing workflow so your staff doesn’t experience disruption.
(860) 500-1471
Our remote billing model ensures every provider—from Newark to Princeton—receives the same high-quality, consistent support.
SERVING CONNECTICUT AND SURROUNDING COMMUNITIES
