Support Services

Medical Claims Processing Services


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ATP2 provides highly qualified medical claims processing staff that performs a variety of financial administrative accounting functions that meet or exceed the finished claims quality matrix and quantity.

Specific support functions can include:

• Review and prioritization of medical claims
• Identification and expediting of high-priority claims
• Review of medical claims for completeness and accuracy
• Preparation of medical claims for payment
• Resolution of data discrepancies identified during payment process
• Interface with customers
• Interface with internal activities, including Mail Room and Help Desk Operations
• Processing of medical claims invoices

The following is an example of medical claims processing functions that can be provided by ATP2:

Medical Claims Data Entry. Medical Claims data entry typically begins with the receipt of claims via mail, by means of electronic transmission, or through submittal via fax. Ultimately, these documents will be entered into a Document Management System payment queue either directly, or via Optical Character Recognition (OCR) program where they will be indexed and routed for execution.

Claim Processing. Medical Claims personnel will review claims for completeness and accuracy based on evaluation criteria specified in applicable SOPs.

When documents are found to be missing information that cannot be located and inputed using internal databases, the claim will be returned to the sender via fax or mail. Invoices that are approved for payment will be processed by ATP2 Team personnel where they will be entered into a claims processing database for payment validation and authorization. Typically, invoices authorized for payment are then entered within a Financial Management System (FMS) for payment.

Medical Voucher Examination. Medical voucher examination is performed by ATP2 Team personnel to ensure authorization for payment is based on receipt of all required documentation and compliance with applicable processing requirements. ATP2 personnel will examine vouchers, claims, and payment requests to ensure that all documentation, coding, and other justification is sufficient to allow payment.

Examples of specific guidelines can include:

• Current Procedural Technology (CPT)
• Healthcare Common Procedure Coding System (HCPCS)
• International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
• Tenth Revision Clinical Modification (ICD-10-CM)

If data is deemed inadequate for payment, the claim is submitted for resolution and retained in a “pending” queue. Claims approved for payment by the account technician are bundled and batched at the end of the day and sent for payment.

Process Bulk Claim Submissions. Bulk claim submissions are received from facilities or agencies that handle large groups of individuals such as detained illegal aliens.

ATP2 Team personnel will verify the accuracy and completeness of claims. ATP2 personnel will examine vouchers, claims, and payment requests within the claims database to ensure that all documentation, coding, and other justification is sufficient to allow payment.

Examples of claims compliance can include the following:

• Health Care Financing Administration – 1500 (HCFA-1500)
• Uniform Bill 92 (UB92)
• Current Procedural Technology (CPT)
• Healthcare Common Procedure Coding System (HCPCS)
• International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
• Tenth Revision Clinical Modification (ICD-10-CM)

If data is deemed inadequate for payment, the claim is forwarded for resolution and retained in a “pending” queue. Claims approved for payment by the account technician are bundled and batched at the end of the day and sent for payment.

At ATP2, our success in providing a high level of customer satisfaction is built upon our continuous recruiting efforts to meet the ever increasing demand for quality medical claims processing. This is attained by enlisting the necessary training and measured performance metrics, combined with employee satisfaction in a work environment that provides proper management, rewards, and benefits.