1)   Patient Information related to demographics : This should be entered at front desk in our software which includes patient demographic, insurance and appointment information. The form that is filled out in your office by your patient will suffice. Should your form lack the necessary information to file your claims, we will notify you.

2)   Super Bill/Treatment Form : This must include ICD-9 and CPT codes, Dates of Service, filled in by the doctor or nurse online using Computer, PDA or Pocket PC. ‘This is a encounter form or customized ticket which can be printed in batch or individually.

3)  Copy of Insurance Card : The insurance card should be scanned in our system. We also need a copy of Driver’s License for address verification to be scanned at the time of patient’s first visit.  We do not require any paper from your office. This is the only way this information will be accepted.

4)  Verification of Patient's Benefits : Patient Eligibility Verification should be done at the front desk level before the patient enters the office. You can use any online tool that you have available or we can make a suggestion. This is not required for billing purposes except for those patients who provide expired insurance; therefore we suggest eligibility verification for each patient.

5)  Insurance Authorizations/Referrals : Must include Referring Physician Name, Address, Phone, and License #. This is mandatory for those cases that require authorization from an HMO or for hospital procedures. Doctor’s office will take the authorization and enter the # in the Software. We will retain the claims if this information is not available in the system.

6)  Routinely: Day End Wizard will be run (performed) at the doctor’s site and includes the patient payment that was collected at doctor’s office and a copy to be emailed to PracticeForces. We do not need any receipt copy of the payment or credit card summaries. This day sheet will enable us to verify the patient payments.  If this is not provided, we will validate the payment posted in the system and send the patient statement accordingly.

7)  Copies of all Insurance Carrier Remittances/Payments (EOB’s) :
We will be receiving your all payments from Insurances with EOB’s in our PO Box. Your patient payments will also be coming to our PO Box. For Medicare we will be using your existing address and receive electronic EOB only. You can scan all EOBs or fax them to us. We have a digital fax server that scans all of your documents as you send them to us. Consequently, nothing will be lost and we can conveniently provide you with remote access to them should you need any.
However, we suggest Electronic Remittances for following carriers i.e.: Medicare, Medicaid, Aetna, UHC, BCBS and Humana so the copies can be stored electronically in the system and accessible by anyone with authority who runs the system. 

In regards to any other documents that relate to claims, patients, patient accounts, and insurance carriers i.e.: letters, denials or rejections, please fax them from your practice to our designated fax number.

( Please Note: We need to register the CSID of your fax machine in order to keep your documents secure and routed automatically to your account executive. Please make sure to send all the faxes from the machine that is registered with our system. )

Remember: If we receive information that is not readable or incomplete, it will either be sent back to your office or placed on hold, thus delaying submission of your claims. Please check the information before sending it to us. We can only be as strong as the link between the Practice and Payor. We are fully dedicated to providing you with the excellent service you deserve and the information we receive supports our objective to deliver that level of service.

8)  Hospital Visits: You need to fax us the following documents for hospital procedures. You have choice here to adopt paperless process or send us the charges to enter into the system.

1. The first paperless process allows you to enter the charges by yourself in the computer or using PDA at the point of service.
2. Paper based option is as follows
3. Patient demographic with insurance information should be entered by Doctor’s office/on-line access (ask for details).
4. All face sheets from the hospitals with ICD and CPT codes marked can be faxed to us or Hospital Information Systems access can be provided to us - as your business partners. We can directly pull the face sheet from the Hospital system and enter the demographics into our system.  However, we still need to receive the procedure codes and summary with correct modifiers.
   You can fax it to us or we will provide you with the telephone access so you can dictate the Patient Name, DOS, ICD Codes and CPT codes with Modifiers and Period of Hospital Admission. Hospital visits can be posted on weekly basis or at your convenience.
5. Patient’s correct insurance information and authorizations must be provided by the doctor’s office. If we don’t have the insurance information, we will bill to the patient. We have the online skip tracing tool so we are able to find the correct address and information of any US Resident. We will utilize this utility to correct wrong information provided by the patient or hospital.

9)  When and How To Submit Information : You will be sending us all the above required information electronically by posting into our billing system or via fax. We Do Not provide physical pickup. If hand delivery is required, it can be mailed to us via Next Day delivery and we will follow through with the appropriate activity.

10)  Posting Payments & Tracking Services : 80% EOB will be received electronically and posted electronically should you receive any EOB on paper will be picked up from the PO Box or lock box.

Once we have filed a claim and have allowed sufficient time for your claim to reach the insurance company, we will contact the insurance to check the status of your claim.

If we receive an EOB denying certain procedure(s), we confirm that your diagnosis and procedure format is correct; we will then submit a Letter of Medical Necessity for the procedure(s) that have been denied. You will receive a copy of the letter and attached will be a copy of the unfavorable EOB. We will then follow up for payment.

If you receive an EOB requesting a narrative report, office notes, etc. - Please forward us a copy of this EOB (with an authorized signature) showing that you are aware of the request. When the report has been mailed to the insurance (always include a copy of their EOB with your report), please send us another copy of the EOB showing the date that the report was mailed to the insurance. We will then pursue for payment.

In the event we receive an electronic request for additional information, the request will be forwarded to you for completion. Please also notify us when the information was sent to the insurance by marking the date on the form sent to you and returning it to us in your weekly submittal envelope.

We will keep the lines of communication open and will submit any requests or questions we may have to you.

11)  Collections / AR Management :  We use a soft collection method that presents a friendly and casual experience for your patients. By default we send 3 statements to your patients, if the statement comes back with the wrong address information your staff can use our online tool and update the correct information in the system so next time the statement will go to the correct address. After sending 3 statements, we call the patient and try to receive the payment through payment plans or the way your patient is comfortable paying.

If we can not trace the patient and they deny it completely, we bring it to your notice and send the same notice to your collections agency.
( Please Note: We do not write off any amount in the system without your approval. )

Remote Bank Deposits: PracticeForces will make the bank deposits in clients account in bank of America. Please provide your bank deposits to us in advance. We can deposit any amount electronically in real time using remote deposit service which is extremely efficient and quick.

12)  Invoices & Payment Instructions : After we close the month on the last day of any given month, we will generate an invoice, on the first day of each next month, based upon our contractual fees.

13)  Billing Terms for All Clients : Payment and our receipt of all PracticeForces invoices are expected in net 7 days, unless otherwise specified in your contract. After a 4-day grace period we reserve the right to include a late charge on your next invoice.

If you feel you are in need of assistance while gathering the required information, please contact our office at the number listed below.
When your registration has been processed, you will receive our standard Contract for Services and any EMC Agreements that a participating carrier may require when applying for your EMC rights.  Please sign and return the original copies to PracticeForces Services as quickly as possible to prevent delays in receiving EMC approvals.  If you have any questions/concerns, please contact us. Thank you.  

CONTACT US AT :
PracticeForces
34041 US Highway 19 North
Suite A
Palm Harbor 34684
Phone : 727-771-1300
Fax : 727-786-5768
Mail ID : sales@PracticeForces.com