Billing | Lotus Billing

Our Comprehensive Approach

Our comprehensive billing service covers every aspect of your revenue cycle—from primary claim submission to payment posting.

We manage:

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Primary and Secondary Claims

We generate and submit claims quickly to reduce the risk of timely filing denials.

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Remittance Posting

Once an insurance company processes a claim, we post electronic or paper remittances to keep your financial records accurate and up to date.

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Denial Management

Our team follows up on denials, identifies their root causes, and promptly resubmits corrected claims or appeals.

By handling all of these billing details, we help you maintain a steady cash flow and free up valuable time to focus on patient care.

Our Billing Process

We believe in transparency and efficiency at every stage of the billing cycle. Below is a step-by-step look at how we manage claims and secure prompt payments:

1. Quoting Benefits

Before services are provided, we call the patient’s insurance company to:

Confirm coverage details, such as co-payments, deductibles, and any benefit limitations.
Identify any out-of-pocket costs the patient may be responsible for.
Determine whether the patient’s plan requires pre-authorization for upcoming services.

This upfront verification helps set proper financial expectations for both you and your patients.

2. Requesting Authorization

During the benefit-quoting process, we identify if the patient needs authorization—the insurance company’s approval to proceed with treatment. For services like ABA therapy, multiple authorizations may be required (e.g., one for initial assessment and another for treatment). Our team:

Submits authorization requests with clinical documentation, including the assessment and treatment plan that establish medical necessity.
Tracks responses from insurance companies, making sure you receive clear guidelines on how many units are covered and for what duration.
Follows up on pending authorizations to avoid treatment delays and missed reimbursement windows.

3. Sending Claims

Once your services are rendered:

We generate and submit claims to the insurance company.
Each claim includes session details, patient data, provider information, applicable codes, and any required modifiers.
We monitor submission deadlines and payer guidelines to minimize denials for timely filing or missing information.

This meticulous approach ensures your claims are accurate and have the best chance of being approved upon first submission.

4. Posting Remittance

When an insurance company processes a claim, they issue a remittance that explains their payment decision. This can arrive electronically (ERA) or via paper remittance. Our responsibilities include:

Reviewing Remittance: We verify approval amounts, patient responsibility, and any noted adjustments.
Posting Payments: We record insurance payments in your system to maintain up-to-date financial records.
Coordinating Patient Billing: If there is a co-insurance or deductible remaining, we ensure patients are accurately billed.

Accurate remittance posting not only helps with financial reporting but also paves the way for smooth patient collections.

5. Denial Management & Claim Follow-Up

Even the most carefully prepared claims can be denied. Our team tackles denials head-on by:

Reviewing each denial reason—whether it’s related to authorization, modifier usage, or timely filing.
Correcting and resubmitting claims with appropriate documentation or codes.
Contacting insurance companies directly if additional clarification or appeals are needed.

By actively managing denials, we work to maximize your reimbursements and reduce the number of unpaid claims in your AR.