Billing and Revenue Enhancement

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 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. The UHealthSolutions team offers a full range of billing and claiming services:

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

Examples of Our Solutions

Since 2006, we have provided Medicare Part D billing services for a large state client.

  • Examine pharmacy data in 21 state-run facilities and enroll dual-eligible patients in both Medicare and Medicaid.
  • Recover state funds by billing appropriately for services covered by Medicare Part D (process 260,000 claims and generate more than $20 million in revenue annually).
  • Reduced the 30 percent pharmacy rejection rate from 30 percent to 7 percent or less.