“Capario already has the connectivity to the Medicare, Medicaid and Blue Cross/Blue Shield payers in every state. We can branch out without any capital outlay with our program software vendor.”Sturm, Vice President, Information Systems
Physicians' Choice, LLC
Physicians' Choice, LLC, is a billing service for 21 emergency medical groups. Based in Woodland Hills, California, the company has been in business since 1999 and has about 80 employees. Physicians' Choice has been a Capario client for six years.
Physicians' Choice transmits an average of 48,000 claims a month - half of which are sent through Capario. The remainder is sent through other clearinghouses or via direct submission. Jon Sturm, vice president for information systems, has been in the medical insurance billing business for more than 20 years.
The Business Issue
When his staff sends a claim to an insurance company, they need to know if the claim was accepted or is pending, Sturm says. If it was rejected, they must know how to correct the problem. The easiest way to get the necessary feedback is to send claims through Capario.
"We place a huge importance on reconciliation of files we send in," Sturm explains. "It's not cost effective to hire someone just to do reconciliation, and the reports we get back from Capario save us that."
For even more help in reconciling claims, Physicians Choice plans to begin using Capario’s claim tracking service. The service offers Capario’s internal status as well as the payer standing for easy retrieval and sorting according to the status, payer, or standard HCFA 1500 field. Advantages of the service include:
- Faster availability of reports
- Unparalleled access to information on claims status
- Step-by-step guidelines on how to correct rejections
- Query process to manage aging claims
Another advantage to using Capario, Sturm says, is the company's national reach. "With government payers, we can go into a new state very quickly. Capario already has the connectivity to the Medicare, Medicaid and Blue Cross and Blue Shield programs in that state. We can branch out without any capital outlay with our program software vendor."
The bottom line, of course, is getting claims paid, and that makes Sturm a loyal Capario customer. "I use Capario because I know that historically we have far more successful transactions there than with any other company."
Capario has a long-standing history of helping physicians, payers and other healthcare organizations reduce claims processing costs and expedite revenue cycle management processes.