Reimbursement Support Services
Reimbursement Support Services are a unique set of services Quadax offers to labs that are bringing new clinical tests to the market. New technologies are often expensive and present challenges for obtaining reimbursement since insurance carriers may not have an established coverage policy. Key components of the service are the Patient Advocacy System (PAS) software, a Web-based application developed by Quadax that logs and monitors the status of each claim or case, and our Patient Advocates, who assist patients through the reimbursement process.
Patient Advocates guide patients through the steps for obtaining payment from their insurance, and can even work directly with patients to help them make informed decisions prior to having a test. Patient Advocates log all communication from patients and insurance into the system and have real-time access to patient account information. PAS includes a robust reporting system with options for tracking the status of cases by salesperson, territory, insurance, or physician.
Reimbursement Support Services is a flexible service that can be customized to your lab's unique situation. Our patient services can include any of the following components:
- Benefit Investigation. Prior to testing, Patient Advocates work with the insurance carrier to determine the benefits for which the patient qualifies based on policy limits, deductibles, and co-insurance amounts. Patients are informed about their financial responsibility and can make decisions based on it. Patient Advocates are available to answer patient questions.
- Prior Authorization. If a plan requires it, Patient Advocates work with the patient and ordering physician to obtain pre-authorization for the test.
- Claim Processing. After the test is performed, a claim is submitted to the insurance carrier for payment with any necessary supporting data. Patient Advocates keep patients updated about the claim status.
- Ordering Physician. Patient Advocates work directly with the ordering physician and office staff to obtain necessary medical documentation justifying a patient's need for the service. The physician is kept current on communications with the patient and carrier.
- Appeals. If insurance denies payment for all or part of the claim, Patient Advocates will file many levels of appeals, including independent medical review. Patients and physicians might be asked to assist in the process.
- Patient Responsibility. After exhausting all insurance benefits, patients are responsible for any balance remaining. If needed, Patient Advocates work with patients to qualify them for financial assistance or to set up payment plans.
Reimbursement Support Services provide valuable tools for marketing new technologies. When a new test is backed by Reimbursement Support Services, physicians have confidence that every effort will be made to obtain the maximum benefits from patients' insurance plans. They are more inclined to order a test that will not be a financial burden for their patients.
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