Medicare and Medicaid billing, done carefully

Eligibility before the visit

Check Medicare coverage with CMS and Health First Colorado coverage with the state, before the first visit and whenever something changes. Results show in plain words, with warnings for the things that tend to cause denials later.

Medicare and Medicaid together

For patients who have both, claims go to Medicare first. When Medicare's payment passes to Medicaid automatically, the platform follows it. If the crossover never arrives, it prepares the Medicaid claim so it doesn't get lost.

Dual-eligible patients

Patients covered by both programs, including those in Medicare savings programs, are marked "do not bill the patient" for cost sharing, as the rules require, so a balance never goes to someone who shouldn't receive it.

Filing deadlines

Every claim carries its payer's filing limit. Claims approaching the limit are flagged to a person weeks ahead, not discovered afterwards.

Codes that don't belong together

Code combinations that payers won't pay together are stopped before the claim goes out, along with missing or invalid provider, patient and insurance details, so fewer claims come back.

Corrections and appeals

If a Medicare claim needs correcting, it goes through the right process for that payer. Denials come with a draft appeal for the provider to finish, and every change keeps the old and new codes on record.