Billing and Claiming

With so many different public and private insurers, each with their own policies and procedures, third-party billing can become a time-consuming task for even the most skilled health care organizations. Whether you’re dealing with Medicare, Medicaid, or a commercial insurer, the rules of the game change so frequently that actually generating revenue from the process can be difficult.

That’s how UHealthSolutions can make a difference. Our team has current, in-depth knowledge of billing and claiming procedures — and we don’t give up easily.

UHealthSolutions can help you achieve the results you want by drilling down to find all sources of revenue, not just the ones that are easy to claim. Our expert team offers a full range of billing and claiming services:

• Collecting and analyzing drug plan data for third-party billing and Medicare Part D
• Reviewing claims against drug formularies or preferred drug lists
• Coordinating claims
• Facilitating electronic submission of claims to health care plans, including Medicare Part D
• Troubleshooting and resolving outstanding and rejected claims
• Preparing records for financial appeals hearings

Medicare Part D billing

Our team has extensive experience with Medicare Part D billing and claims processing. We understand that it’s essential to have trained, highly qualified professionals available to make sense of complex data. That’s why our team includes

• Pharmacy technicians to analyze prescription claims, ensuring that all appropriate points of data are taken into account
• A registered pharmacist on our staff to provide clinical guidance
• Accounting specialists to reconcile remittances

Our knowledge of prescription medications and insurance coverage — along with the high priority we place on finding all sources of revenue — helps us maximize your reimbursement rates.

Medicare Part B billing

UHealthSolutions also provides vaccine administration billing for Medicare Part B recipients through the Community Immunization Identification Project.

Through this program, we help public agencies in Massachusetts recover the administrative costs of providing vaccinations to the public. UHealthSolutions offers direct billing services to these state and local agencies by processing claims and billing the appropriate federal health program on our clients’ behalf.