Medical Billing & Coding Services for Maine Providers
Medical Billing in Maine for Providers & Practices
Our medical billing & coding services are provided to practicing providers and groups in Maine by utilizing the latest in information transfer technology!
The medical billing company you choose to handle your medical billing and management functions should be experts at what they do, and more importantly, experts at increasing provider revenue… not just a company that is close to your practice in Maine, but someone who genuinely cares about you, your revenue and your practice.
With successful and satisfied clients all over the United States… the medical billing company that most successful Maine Providers choose is Outsource Management Group, LLC.
Blue Cross Blue Shield of Maine makes finding information for additional clinical information needed very simple. The Blue Cross Blue Shield of Maine provider portal has many informative tools on their website.
As providers, we often encounter times when an insurance may request further clinical information in order to process and adjudicate claims. Blue Cross Blue Shield of Maine has an informative tool on their provider website with information explaining all the reasons when further clinical information may be necessary.
Sometimes claims involving pre-certification, prior-authorization, and pre-determination or some other form of utilization review, including, but not limited to claims pending for lack of pre-certification or prior authorization may need further clinical information to review before the claims are processed and adjudicated. Claims involving medical necessity or experimental/investigative determinations, or claims for pharmaceuticals requiring authorization, may also require further clinical review before those claims are processed further.
Claims may also be held for adjudication as insurance may be requesting clinical information due to certain modifiers that are present on the claim. A common modifier that triggers the hold would be modifier -22, which tells the insurance company that the procedure was an “unusual procedural service”, which then requires further clinical investigation as to why it was unusual. Also, claims that have procedural unlisted codes will often trigger more clinical data review.
Sometimes further clinical review is necessary when it cannot be determined from the face of the claim whether it involves a covered service,, thus the benefit determination cannot be made without reviewing the medical records (including but not limited to pre-existing condition issues, emergency service, and specific benefit exclusions).
Claims that Blue Cross Blue Shield of Maine determines that have a reasonable possibility of inappropriate or even fraudulent billing, may also be subject to further clinical review. Also, claims that are subject to an audit, may also be held for adjudication until further medical data is submitted.
It is sometimes necessary that Blue Cross Blue Shield of Maine may request further clinical evaluation and review of specific claims, but they make it easy in the steps to follow to get that clinical information to them, and the many reasons why they might request further documents.
Click Here to visit the Maine BCBS website for more information.
Partner with the leading medical billing firm & increase your revenue now!
By utilizing our medical billing for Maine physicians you are taking the first step to increasing your revenue. As your business partner, we become a seamless part of the daily function and overall financial health of your practice. We take great pride in continually verifying that our Maine providers are being reimbursed for everything they deserve. Contact us today if you’re working long, hard hours and tired of needing more revenue. We will become your partner and guide you to a better bottom line!
