Billing Services

PCM Lite utilizes methods that support aggressive case management, which provide substantially discounted arrangements with local hospitals and providers. Additional benefits include claims “scrubbing” and claims processing. We aid in streamlining the billing process for medical claims, thus decreasing the opportunity for error and ensuring every facility dollar is maximized.

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Why is case management important?

Case management encompasses assessing, planning, coordinating, and monitoring health care services for the unique needs of individuals in custody. This approach involves collaborating with medical professionals, behavioral health professionals, and correctional staff to ensure access to necessary health care treatments, medications, mental health services, and follow-up care. The goal is to provide comprehensive health care while managing chronic conditions, addressing acute medical needs, and promoting overall well-being while minimizing health-related risks during incarceration.

What is claims "scrubbing"?

This is an automated review process that validates medical claims before submission to insurance companies or payers. It involves software checks to ensure completeness, accuracy, compliance with coding guidelines, and adherence to insurance policies. By verifying patient demographics, provider details, diagnosis and procedure codes, and required documentation, it aims to catch errors or inconsistencies that could lead to claim denials or delays. This proactive approach helps in correcting issues beforehand, improving the chances of successful claims processing, faster reimbursements, and better revenue cycle management for health care providers.

What is involved with claims processing?

Claims processing involves the administration and handling of medical claims for services provided to patients. It includes the submission, review, and payment or denial of claims for health care services. The process involves coding and documenting medical services, submitting claims to the appropriate payer (such as government agencies or private insurers), and verifying the eligibility of patients for coverage. Claims processing ensures that health care providers are reimbursed for medical services delivered to patients while adhering to specific regulations and guidelines unique to the correctional setting. This procedure is essential in overseeing the economic aspects of delivering health care within correctional facilities.