Apex Reimbursement Specialist

Location :

2835 Smith Ave, Suite 201, Baltimore, MD 21209
Added by Apex Reimbursement Specialist, at 21 March 2025

Here's a summary of the services provided:

**Insurance Negotiation**:
- Verify accuracy of fee schedules per provider and location.
- Negotiate with insurance carriers to secure higher reimbursement rates.
- Provide detailed recommendations on increased reimbursement per code schedule.
- Ensure proper implementation of approved recommendations.
- Deliver a monthly report on increased revenue due to higher schedules.

**UCR Fee Analysis**:
- Generate and analyze a report identifying the percentiles of fees based on current claim activity in each office's geographic area.
- Compare these fees to current office fees.

**Coding & Compliance**:
- Perform a forensic review of practice analysis reports to ensure revenue generation, accuracy, and compliance.
- Provide a written report with recommendations.
- Offer a 30-minute consultation to discuss findings and next steps.

**Network Optimization**:
- Identify all networks in which providers participate per location.
- Identify carrier networks where providers are not in-network.
- Offer recommendations on which carriers to add or remove per office.

Here’s a more concise summary of the **Unlimited Credentialing/Re-Credentialing** services:

**Verification**:
- Confirm provider roster and network status with carriers.

**Provider Management**:
- Collect and manage provider data and supporting documents (e.g.

, licenses, insurance).
- Send reminders for expiration dates and review provider info for accuracy.

**Carrier/Payor Management**:
- Request, complete, and submit forms to carriers.
- Follow up with carriers if additional information is needed.

**Follow-Up Management**:
- Ensure carriers receive and process documents.
- Notify providers of “in-network” dates and validate data accuracy.

Here’s a concise summary of the services:

**TIN Change Management**:
- Verify provider network participation and complete TIN change forms.

**Credentialing**:
- Unlimited dental carrier credentialing and re-credentialing.
- Create a digital storage for provider info and ensure plan participation by office.
- Ensure compliance with state licenses, DEA, and other certificates.

**PPO Insurance Negotiation**:
- Verify current fee schedules and negotiate higher reimbursement rates.
- Provide detailed recommendations and implement approved increases.

**UCR Review**:
- Generate a UCR report with ADA code fees for the desired zip code.

**EFT Set Up & Transition**:
- Verify necessary documentation/portal requirements with insurance companies.
- Complete forms or assist with carrier-specific portals.

**EOB Validation**:
- Verify correct carrier relationships and fee schedule accuracy via EOB samples.

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