These are the responsibilities Practisync can take off your hands: 

• Pre-submission claims review to minimize rejections and capture errors that may disrupt or delay clean processing of the claims 
• Electronic claims submission on a routine and timely basis 
• Paper claims submission on a routine and timely basis 
• Rejection management from clearinghouses, which includes the review and correction of claims and/or communication to the practice for information or action items necessary there 
• Payment posting – including paper and electronic remittances. This includes adjusting accounts per the claims processing data. 
• Conducting appeals related to erroneous claims denials and/or providing information and support to the practice if additional action steps or information is needed from the practice to execute appeals
  • Communicate with the practice when appeals will not be successful or if particular claims are not eligible for appeal 
• Provide collection efforts for aged insurance receivables up to 30 days prior to your official onboarding date. This time period may vary slightly if other arrangements have been made. 
• Utilize the shared “wrap up”/communications log for patient account and revenue cycle related matters. This includes responding to requests and instructions from the practice. Note that, in some cases we also utilize note/alert/task systems in some EHR software programs. 
• Ongoing touch-base emails and/or calls with the practice to ensure streamlined communications. These touch-bases are at the discretion of the practice and the biller, based upon preference and need.  

These are the responsibilities your clinic will continue to manage: 

• Ensure your payors are properly enrolled for electronic claims submission. As an effort to ensure claims are received by payors quickly for processing, we work to minimize paper claims.  
  • TriZetto can assist clinics with enrollment training through, however the clinic is responsible for completing their enrollments
• Provide appropriate access to payer portals that are utilized and/or necessary for revenue cycle management. 
• Remittances that arrive via fax, mail or in a payer portal must be shared by the practice to the “Shared EOBs” folder for your practice. Here, your biller will have access for review and posting of all remittance data.  
  • With EDI (electronic claims setup), most remittances should be eligible to come into your clearinghouse and billing software, for direct biller access and posting. 
• Ensure complete and accurate patient account setup 
  • This includes entering patient information, complete patient demographics and insurance/payer information for billing. Patient accounts must be completely established and assigned to insurance before your biller can take next steps for claims preparation. 
• Communicate via the wrap up/communications log in the shared folder for account related items. This includes responding to action items requested by your Practisync billing specialist, as well as communicating requests and instructions from the practice. Emergency items are always welcome by email, so your biller can prioritize addressing these items as quickly as possible. 
• Any internal items, such as spreadsheets to log payments, must be done at the clinic, as applicable. Practisync billers can provide specific reporting through your software, at any time upon your request. However, if additional reporting mechanisms are utilized by the practice, this must be maintained internally at the practice. 
• Preparing and sending patient statements as well as answering any direct patient questions related to billing/balances. 
  • Note that you are always invited to reach out directly to your biller to request information or clarification to best help a patient, however, to minimize disruption, all patient communications will be the Practice’s responsibility.  
• Verify insurance benefits and obtain prior authorization if required by a patient plan.