Provider Suite Features

The BillDME Provider Suite greatly simplifies the complex and tedious process of billing insurance for DME. For our provider partners, the process can be completed entirely through our secure portal. Simply submit patient insurance information for verification and then upload a signed Patient Agreement/Letter of Medical Necessity for approved patients. Depending on the services you require, we will handle the fulfillment, billing, collections, and patient follow-up. As a result, doctors can focus more attention on caring for patients.

Verifying insurance is one of the most important parts of the billing process. A lot of time, equipment, and money may be lost if the patient’s insurance is not properly verified. The Provider Suite automatically gathers a patient’s up to date insurance information and determines whether they are approved for equipment that is deemed medically necessary. Verification results can be determined instantaneously. Moreover, our verification process incorporates custom cost analysis, which allows you to customize how results are determined.

Custom Cost Analysis is where we give you some control over how the Provider Suite classifies the insurance you send for verification. Beyond simply returning coinsurance and deductible values, we actually factor in the value of the equipment and other overhead costs to let you determine for what percentage of patient and insurance liability you are comfortable billing. We have incorporated default values into the system based on our experience, but with Custom Cost Analysis you make the final determination with regards to what is eligible and what is denied.

The Provider Suite features a sophisticated algorithm that uses far more than coinsurance, deductible, and out of pocket values to approve patients. Our Verifications Team collects aggregate data and analyzes trends to develop rules for the Provider Suite to reference prior to determining whether a patient is eligible or denied. These rules can apply to a particular insurance company, piece of equipment, policy value, or, in some cases, all of the above. It is even possible to incorporate rules unique to your account allowing further customization of your results.

The key factors for timely reimbursement are accuracy and compliance. To ensure accuracy, we have multiple checkpoints across every phase of our process in which we review and verify pertinent information. Compliance is more complicated. Best practices vary by insurance company, plan type, and equipment. There may be differences in when and how the claim is sent, equipment covered, codes and modifiers, allowed amounts, and more. Due to specialization and experience, we know when and how to bill which companies for what equipment.

In order to maximize the effectiveness of our efforts we compile and analyze aggregate data to identify trends and make adjustments accordingly. By providing you with detailed verification and financial reports, we provide you with the opportunity to do the same. Verification Reports make it possible for you to identify adjustments that can be made to tighten or loosen requirements for approval. Our Financial Reports foster transparency in our business relationship and give you a real time look at how much has been paid by whom and when.

Your confidence when submitting electronic protected health information (e-PHI) through the Provider Suite is essential. That is why one of our main areas of focus when developing the Provider Suite was the security of provider and patient information. We have made efforts to not only meet, but exceed the recommendations of the HIPAA Security Rule. We use encryption methods backed by hardware security modules to ensure e-PHI and secure user information is protected.

The Provider Suite allows for API connections to move a greater amount of data more quickly. Most of the services available in our online system are available through our API services. Quickly send patient data for real-time verification results and receive updates on patient order status right through your existing patient management software. We can supply your development team with all the documentation they need to get your system connected to the Provider Suite API.