CLAIMS ADJUDICATION & RESUBMISSION

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Grandeur Healthcare is a national BPO organization with a highly acclaimed HEALTHCARE solutions division. Led by a dedicated team of experienced HEALTHCARE revenue cycle managers and IT experts, Grandeur Healthcare provides essential business services to more than 500 HEALTHCARE offices across the country every day.

You can choose to streamline your healthcare claims adjudication by choosing to work with us.

We offer complete claims adjudication, processing, and resubmission for your office based on your authorizations and provider contracts. We also generate monthly reports that summarize claim expenses by service and specialty type. Some of the features include:

  • Enter and process all claims received for services
  • Create and submit positive payment files as needed
  • Generate payment and remittance advice repots regularly
  • Ensure accurate payment
  • Request and process new and updated provider contract information
  • Weekly reports of unauthorized claims
  • Generate denial letters
  • Generate accounts payable aging reports and more.

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We have significant experience across the most common HEALTHCARE Applications such as:

  • Dentrix
  • QSI
  • Eaglesoft
  • Practice Works
  • HEALTHCARE Vision
  • Denticon
  • SoftDent
  • EasyDent
  • Proprietary Systems

Claim Submission & Clearing house Denials:

Once all the charges are posted into the system, we submit your electronic claims to the respective payers (including HCFA 1500 claims). We work on all your clearing house denials and give proper feedback with suggestions to reduce the number of claims that do not pass the clearing house. A detailed report will be sent to you on a daily, weekly, monthly, and yearly basis.

Claim Processing:

To expedite claims processing, our proprietary programming software allows us to constantly maintain, upgrade and enhance the billing for service processes

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  • Automated Claim Processing
  • Advanced Customer Services
  • Referral Processing and Preauthorization
  • Flexible On-Demand Reporting
  • Premium Billing
  • Integrated Web Access
  • Integrated claim scanning