August 2008 Newsletter

Quadax Expands Reimbursement Support Services

By: Director, Reimbursement Support Services

Quadax continues to expand Reimbursement Support Services, which are designed to improve reimbursement levels for leading-edge healthcare technologies. When products and services are new to the market, they present challenges in obtaining reimbursement from third-party payers. Reimbursement Support addresses these challenges through a unique combination of skilled people, customized processes, and our proprietary software, called Patient Advocacy System (PAS), which is integrated with our core billing service.

Central to Reimbursement Support are the pre-billing, appeal, and reporting modules in PAS. In the pre-billing stage, our patient advocates confirm benefit information from a patient’s insurance carrier, handle any prior authorizations required, and then discuss the reimbursement process with the patient. The PAS software provides a record of these efforts and an automatic workflow for each step in the process. If all or part of a claim is denied, the appeals module automatically files an appeal with the carrier. If necessary, our skilled appeals staff submits higher-level appeals with case-specific clinical support. The reporting module provides payment and appeal data that is valuable to our clients as they pursue contracts with payers.

Reimbursement Support clients include providers of services and products that are critical for the treatment of diseases such as cancer and diabetes. New clients in 2008 include molecular diagnostic testing labs and a medical device company. To support our current and planned growth, we have added staff in account management, training, production operations, and quality assurance. They come with varied backgrounds in project management, data analysis, and clinical healthcare. All, however, are dedicated to the Reimbursement Support Services goal of ensuring claims for non-contracted services are paid at the highest reimbursement rate.

For more information about Reimbursement Support Services, contact your Quadax Service Representative or .