ClaimCare^® - The Medical Billing Professionals
At the Forefront of Comprehensive Medical Billing

When asked what sets ClaimCare apart from other medical billing companies, President/CEO Carl Mays II answered with 3 specific things:

(1) Mays, a mechanical aerospace engineer by education and training who worked with Boeing designing helicopters for several years, says ClaimCare has an engineering mindset. They have a tightly designed process they follow internally and have key metrics that measure all the steps in that process, which allows them to know they’re executing as expected.

(2) They have developed proprietary automation. Rather than using staff for very routinized, repeatable tasks where there’s not really any decision making needed, they’re able to use this automation to free up staff to do the things where you actually need well-trained, intelligent, and motivated human beings to help get money through the door for clients

(3) ClaimCare is 100% U.S. based. Clients view this valuable because they feel it improves communication between the biller’s team members and the client. They also feel it makes sense to have billing done in America where billers understand our unique healthcare system involving Medicare, Medicaid, and private insurers versus those in other parts of the world.

ClaimCare’s processing technology encompasses all the elements of claim submission and follow-up, including a practice management system, scheduler, electronic medical record software, easy-to-use dashboards, practice analytics, and recommendations. ClaimCare helps clients circumvent claims denial, downcoding, and errors caused by manual billing methods.

Allowing clients to focus on what they know best—treating patients, ClaimCare follows a step-by-step approach to medical billing, improving collections and payment turnaround time.

Working closely with clients, the team familiarizes itself with clients’ billing environments and understands the nuances of their practices from a reporting and billing standpoint.

Claims are scrubbed before submission to ensure they clear the adjudication process. Leveraging the power of automation, routinized issues that tend to hold up money are effectively managed. If a claim slips through a crack on a payer’s end and client doesn’t receive updates on payment, denial, or a request for more information, ClaimCare has an answer.

Rather than not give attention to those claims and hope the payer ultimately pays, the claims go into a no-response process through which ClaimCare verifies the patient’s insurance is valid with that payer and the claim is clean. If there are issues, ClaimCare works to take care of them, and then gets that claim resubmitted and follows up on it again.

Being a full-service billing organization, we fundamentally take over a client’s medical coding and billing responsibilities and do everything to keep their cash flowing,” says Mays. “From thoroughly monitoring and submitting claims to following up, posting payments, and generating reports, we handhold the client and ensure their success

In one instance, ClaimCare engaged with a six-physician orthopedic practice that was using an in-house billing system. After analyzing the practice’s billing environment, ClaimCare discovered many of the provider’s services were not getting billed and required follow-ups on claims.

ClaimCare informed the client about the unbilled items and applied ClaimCare’s standardized billing process to follow up on denied and no-response claims to maximize collections. As a result, the client’s average reimbursement per encounter shot up by 8.5% in the first year and by 13% at the end of the second year.

Clients are sent a monthly one-page report card that presents a consolidated view of all key metrics to understand how their collections are faring. The report card is color-coded; key metrics are green if the process is going well, yellow if it needs improvement, and red if there is a critical problem. ClaimCare has virtual visits with clients to discuss the report cards.