How to avoid Medical Records request from UHC United Healthcare requests medical records for most of the claims. After our deep analysis we found that if the total claim charge amount is more than $1,300 UHC is requesting medical records. We tried two claims for different patients with the same proc...

Fee Schedule Analysis and Auditing The insurance allowed amount or the fee schedule is determined by various factors such as insurance plan, provider in-network or out of network status, ACO, PHO, geographic practice cost index, etc. If the practice did not keep up with the ever-changing fee schedul...

Medical Coding Certification Certified Professional Coder (CPC) The CPC medical coding certification validates proficiency in the correct application of CPT, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes used for coding and billing for medical claims in a physician’s...

               Provider Directory It is profile which shows the healthcare provider information in a directory structure on the healthcare payer’s website. Information like providers name, specialty, servicing address, phone and fax numbers will be listed there according to the patient’s...

                                WOL (Waiver of Liability) A medical liability waiver is an advance written notice to the beneficiary used by medical professionals when the services being provided are found not to be medically necessary.  A completed and signed copy of the Waiver of ...