Welcome to Total Soft health care solutions !

USA HQ : Analomink, USA - 18320
India HQ : EON Free Zone, Pune, IND

Provider Credentialing

Total Soft health care ensures that new providers are credentialed with payers and there are appropriate contracts with payers. We also take care of re-credentialing services for existing providers

Physician Credentialing Services allows physicians to spend more time with patients and less time with paperwork. Submit your medical credentialing documentation to Total Soft health care just once and we will take care of enrolling you in the networks you choose.

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Eligibility and Benefits Verification

In the absence of proper eligibility and benefit verification, countless downstream problems are created -- delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment. To avoid these problems, Total Soft health care provides a remotely hosted Centralized Eligibility Unit for Hospitals and Faculty Practice Plans. The solution consists of Total Soft health care staff, technology, management and our expertise with the objective of delivering high-quality, cost-effective patient insurance eligibility and related services. As soon as the required information is verified, we immediately report back to our clients with the required reports or by directly entering the information in the Medical Billing software

Total Soft health care Eligibility Verification Services has the potential to:

  • Improve A/R cycles (reduce A/R days)
  • Increase cash collections by reducing write-offs and denials
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Demographic Entries

Our accurate data processing ensures clean claims and does reduce denials drastically. Our experienced team registers all patient information with high accuracy. We ensure to choose the correct Insurance codes from the Insurance master list. We capture specific information based on the software and specialty. We have the ability to make accurate entries looking at scanned images.

Our demographics registration process captures accurate patient, guarantor and insurance information. Our process includes the following checks: New patient or existing patient

If new patient, capture all required information Existing patient – Update latest insurance, patient and guarantor information

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Medical Coding

Our AAPC and AHIMA certified coders take care of specific Specialties and ICD-10 coding. They assist in documenting with appropriate CPT and ICD codes and Modifiers.

We also educate the practice about procedures that can be billed together along with a particular treatment or accompanying medical services. At the same time, we ensure sticking to the coding guidelines.

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Charge Entries

Our team has the ability to process both manual and review electronic charge entries available in EHR / EMR. We capture all relevant information from the super-bill like Performing Provider, Referring Provider, Date of Services, Location, Place of Services, Type of Service, Admission Date, Discharge Date, Number of units, Authorization Numbers, Referral Numbers, ICD Codes, CPT Codes, Modifiers, etc.,

Our team has the experience to link the correct ICD codes to each CPT code avoiding unnecessary rejections and denials.

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Electronic Claims Submission / Rejection Resolutions

We maintain a 99% clean claim standard. We scrub all claims information before submitting to the Insurance Companies. The trends and analysis are shared with the Coding and Claims entry teams. We track all claims we submit electronically through clearinghouses and ensure that insurance payers accept the claims. If we found any rejection our team will resolve immediately

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Payment Posting

The Payments received through ERA / EOB are posted on the system within 24 – 48 hours and the reports are reconciled on a daily basis. Denials are captured & moved to the Denial Analysis team. Two levels of quality audit to make sure the process is at par with international standards Trained staff who understands the patient responsibility too, like the Secondary balance, etc.

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Denial Management

Claim Denials are analyzed carefully and the root cause is defined for each problem. It is then escalated to the concerned teams to make sure the Denials are fixed & also ensure they don’t recur in future. Denial analysis is shared with the client once a week.

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Accounts Receivable Follow-Up

Total Soft health care objective is to improve your cash flow by reducing days in A/R and improving profitability by increasing your collections ratio. Our skilled staff is trained to identify patient accounts that require follow-up and take the necessary action to collect unpaid/underpaid claims

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Credit Balance Resolution

Total Soft health care Solutions specializes in enhancing the financial performance of our clients by seamlessly supporting HCC & Revenue Cycle Management (RCM) and related processes. As a Partner to our clients, Total Soft health care serves as a direct RCM extension to Hospitals and Faculty Practices by leveraging healthcare expertise, technology and qualified resources.

Total Soft health care has built strong working relationships with our clients to consistently meet their needs as credit balance backlogs are prioritized and processed. Incorrect adjustments, erroneous credits and misuse of debit codes makes this Credit Balance task quite challenging, requiring precision, attention to detail and a focus on operational excellence. All Total Soft health care analysts are diligent and well trained to ensure outstanding credit balances are accurately resolved in an expeditious manner. We understand a professional and cooperative environment is the key to resolving more credit balances, many of which become 'account corrections' as opposed to actual 'refunds'; hence, our operational model is highly client-centric.

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Risk Adjustment

We are expert in different types of risk adjustment models that are used to risk-adjust healthcare data such as HCC, HHS & CDPS

We implement best practices to the process error-free as feasible, which results in creating accurate risk scores, the corresponding premium payment, while increasing patient care. These include correctly identifying code gaps, establishing experienced and knowledgeable staffing, performing deep and rigorous quality audits, and implementing the advanced process.

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Revenue Cycle Management

We are expert in Revenue Cycle Management (RCM) includes all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.

With a highly specialized team of financial and clinical experts, we deliver RCM coding solutions specific to the client’s need in working with a client’s host system using its tools. We build efficient workflow processes with a higher output through the use of a hybrid of automated and manual solutions. This is precisely the time to engage with a partner who brings a deep understanding of the revenue cycle. We provide tailored revenue cycle management solutions that cut through the complexity with expertise, operational excellence, and a sophisticated approach. We offer a host of value-added services from Patient Access to Revenue Realization in the RCM space.

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