Platinum Medical Billing Service

Our Platinum Service includes all of the following for one low fee:

Claim Submission

• MBPros will enter your data, transmit your electronic claims and submit your paper claims.
• We guarantee that claims will be submitted accurately by the next business day.  For more information on our money back guarantee, click here.

Accounts Receivable Posting

• MBPros will post all payments from patients and insurance companies and properly post adjustments and deductibles.

Follow-Up of Outstanding Claims

• For any primary claims that remain open at least 30 days after claim submission, MBPros will aggressively follow up on the claims to determine why the claims have not been paid.
• For any claims that have been improperly denied by payers, MBPros will follow up with the payer to have the claim processed correctly.
  • EXAMPLE:  A payer denies a claim because of no referral or no treatment plan approval but you do have a referral or treatment plan approval for the denied date of service.  We will contact the payer to reprocess the denied claim.
• IMPORTANT:  Providers MUST provide copies of EOBs they receive AT LEAST once a week.  The correct procedure would be to scan to PDF files EOBs you receive each day and upload them securely to our Support Suite.
  • We will enroll your practice for Electronic Remittance Advice (electronic EOBs).  Once enrolled this will significantly reduce the number of EOBs you have to provide to us.
  • For practices that fail to provide copies of EOBs at least once a week we will be unable to follow up on your claims (for the simple reason that obviously you do not want us following up on claims that have been paid already).

Insurance Verifications

• For any new patients AND for patients who change insurance we would verify patient insurance benefits*.  Benefit information obtained will include the following:
  • Copay and deductible information
  • Limits on benefits for the year (either number of visits or dollar amount limit)
  • If pre-authorization or a referral is required
  • If claims are sent to a third party payer for processing (such as Magellan Behavioral Health or Beacon Health Options or American Specialty Health Network)
• Some providers may not submit any billing after receiving results of the insurance verification.  For example, a patient may not have any out of network benefits or a patient may have a high deductible making it not worthwhile to submit any billing.
  • In cases like the above if a provider fails to submit at least one claim for a patient within 10 days of the date of the insurance verification, the provider shall be charged $9.95 for the verification.
• There is a limit of 60 insurance verifications done within the billing month.  For verifications performed by MBPros in excess of 60 during the billing month, you are charged $7.95 per excess verification.

Authorization and Benefit Tracking

• Does a patient have a limited number of visits per year?
• Does a patient have a referral through a certain date or treatment plan approval for a certain number of visits?
• For example, a patient may have 20 chiropractic visits per year.
  • Note:  If a patient who has a limited number of visits per year also requires pre-authorization, we are only able to track the number of visits allowed under the pre-authorization…but would then be unable to track the number of annual visits.
• On a weekly basis MBP will email you two reports showing you referrals and authorizations about to expire.  See the below examples.  NOTE:  If Treatment Plan Approval is NOT required but we are tracking the number of visits allowed per year, the Expired Treatment Authorization Worksheet is provided (do not be confused simply because the name of the report refers to treatment authorizations).
  • 14 Days Future Expired Treatment Authorization Worksheet.pdf
  • Expired Treatment Authorization Worksheet.pdf

Platinum Service Fees

• Standard Platinum Service Fee:  $3.99 per claim (minimum fee of $199.95 per month)
• Prepay and Save:  Purchase a 1000 claim Annual Prepayment option for $3.65 per claim
• NOTE:  Under the Annual Prepayment Options, providers must use the number of claims submitted within one year of the date of purchase.
  • For providers who purchase a prepayment option when they first sign up and receive free claims as a promotional special, the one year time period begins to run after the months of free claims.
  • EXAMPLE:  Provider signs up and purchases a 1000 claim prepayment option on June 1st and receives 2 months free.  The one year time period begins to run on August 1st.  Any claims remaining that are not used by the following August 1st are lost as the prepayment option will have ended on July 31st.
  • For providers who purchase a renewal of a prepayment option, the one year time period begins to run the date your office runs out of claims under your current option.  EXAMPLE:  Your office is submitting claims under a 1000 claim prepayment option.  On June 1st you purchase a renewal as you are running out of claims.  Your office submits the last claim under the original prepayment option on June 7th.  The one year time period begins to run on June 7th and thus the claims purchased must be used by the following June 6th or be lost.

Using a Billing Service Charging A Percentage?

• Most billing services charge a percentage of the amount paid by insurance (6-10%).  If you are using such a billing service, STOP throwing your money away?
• Our Platinum Medical Billing Service provides all services (and more!) that a billing service charging a percentage provides but we charge significantly less!
• Check out the References page on our website to see more than 50 practices nationwide who have been using our service for years and would recommend our services!

*Limit of 60 verifications per billing month.  Any verifications done in excess of this per billing month are charged $7.95 per verification.  Follow up of claims is limited to primary insurance claims submitted by MBPros and does not apply to secondary claims.