EMR Software for Behavioral Healthcare
Billing Super powered
We specialize in solutions that will improve your business and ensure quality client care.
Lightning Billing offers solutions to problems providers face with third-party payers.
Most billing companies provide a basic verification of benefits. Lightning Billing takes things one step further, by providing a full benefit analysis.
A basic description of coverage gives the facility an idea of what to expect in terms of reimbursement. Preliminary information obtained includes member responsibility, maximums, and plan-specific information regarding coverage. Lightning Billing knows the benefit of giving providers a more complete idea of what coverage will look like. We utilize our database of plan-specific payment history to give you a realistic idea of what to expect if your client admits.
Verification of benefits
Lightning billing verification specialists will provide your facility with the following information:
Medical necessity analysis
Lightning Billing goes beyond what other billing companies offer by providing an estimate of authorization potential based on a brief clinical snapshot provided by your facility. Using the information gathered, we can more accurately gauge the actual return from a carrier for a client that you have admitted.
What is Utilization Review?
Utilization Review (UR) is the process insurance companies use to approve, authorize or decline services. The purpose of UR is to screen and approve the “least-restrictive” clinical services on a per-case basis. Insurance carriers use this process is to standardize approval criteria in order to only pay for services deemed medically necessary. Additionally, Utilization Review helps prevent fraud, abuse, and the waste of funds on unneeded services.
How important is Utilization Review to my business? Any behavioral healthcare organization that works with insurance should realize that Utilization Review is one of the most critical aspects of obtaining payment. Quality Utilization Review and Management is the starting point from which the financial health of a healthcare organization is derived. Often overlooked or disregarded, improper and/or poorly managed UR limits profitability as well as a client’s length of and access to treatment.
DENIALS & APPEALS
One of the most common denials in behavioral healthcare is based on medical necessity. These denials can occur for many mental health patients. Carriers use medically-based criteria to decide if a client's care can be authorized. If a client doesn't meet specified criteria, claims will be denied due to lack of medical necessity. The Lightning Billing team has been doing this for decades and is the most well-versed team in the business.
Unfortunately, not all billers complete their work in a timely and ethical manner. Plans typically provide time frames in which claims must be submitted. If these time frames are not met, appeals have to be filed.
Some denials are not the fault of the provider or submitting entity. Carriers often deny claims "in error" simply to delay payment. We have extensive relationships with payers that help us help you navigate these tactics.
When A Claim Is Denied
Appeals When A Claim Is Denied
If a claim is denied, the provider or client has the opportunity to appeal the decision. These appeals take time to process but can be won if the correct procedures are followed. At Lightning Billing, we differentiate ourselves from other billing companies by relentlessly pursuing payment on denials and appeals until our clients receive what they are due.