Medical Billing Quality Process

Pacific has two levels of checks for claim processing. This reduces underpayments and denials of claims substantially and provides prompt and accurate settlement of claims.


Stage I: Our quality assurance team does complete checkup of each and every entry of demographic and charges fields in Billing software. This process itself reduces 99% of the errors. Audit is conducted ascertaining maximum accuracy. We audit each and every field in demographic and charges.


Stage II: In this stage of quality audit entries are randomly checked for errors. The fields and the entries such as patient name, DOB, insurance ID and others are verified for Demographic accuracy. Charges Entry checkup includes fields such as CPT codes, ICD codes, modifiers, service provider and referring physician. Claims are then submitted electronically to the insurance company.



Our quality assurance team does complete checkup of entire process of cash posting. Checks are done to validate the fields such as check number, co-insurance transfer and adjustment. Denial and re-submission of claims posting service is very important as it involves a specific time period within which claim has to be re-submitted. Our quality team assures that all denial and re-submission of claims posting is done within time and without missing any record including all supporting documents and information.