Primary care claims service

Our approach:

Data verification and accuracy.
We meticulously verify all necessary information, including patient details, service codes, and supporting documentation, to ensure each claim is thoroughly and accurately documented. This meticulous approach helps prevent errors and reduces the likelihood of claim rejections, delays and/or reclaims.

Electronic claims submission.
Utilising the latest electronic systems, we submit claims to key authorities such as NHS England (NHSE), primary care support England (PCSE), and other relevant bodies. This encompasses the management of shared business services (SBS) claims, public authority claims, and specialised education grant claims, such as those for teaching and deanery placements. Our services also include the submission of local enhanced service (LES) claims, directed enhanced service (DES) claims, and rates reclaims, ensuring a comprehensive claims management process.

Tracking and status updates.
We provide comprehensive tracking of all submitted claims, offering regular status updates and detailed reports. This includes handling claims under the quality and outcomes framework (QOF), calculating quality reporting service (CQRS), and other specialised programs for LES, DES, and rates reclaims, ensuring transparency and keeping you informed at every step.

Our approach:

Denial identification and analysis.
We conduct thorough analyses of denied claims to identify underlying issues, such as coding inaccuracies or incomplete documentation. Our detailed reports highlight these issues and provide corrective action plans to prevent future denials.

Appeals and corrections.
Our team efficiently manages the appeals process, preparing and resubmitting necessary documentation to resolve denied claims. This includes handling complex cases involving QOF, SBS, public authority, LES, DES, deanery claims, and rates reclaims, ensuring that all possible reimbursements are secured.

Our approach:

Accurate and up-to-date coding.
Our experienced coders are proficient in the latest NHS coding standards, ensuring that all claims are coded accurately. This precision minimises the risk of denials and maximises reimbursement rates.

Regulatory compliance.
We keep abreast of all relevant healthcare regulations and updates from NHSE, PCSE, SBS, public authorities, and education-related bodies. This vigilance ensures that your claims are always in compliance with current standards, safeguarding against potential penalties or rejections.

Our approach:

Revenue analysis and optimisation.
We offer in-depth analysis of your revenue cycle processes, identifying opportunities for improvement and optimisation. Our services encompass the management of various funding streams, such as QOF, CQRS, SBS, public authority, LES, DES, rates reclaim, and education grant claims related to teaching and deanery placements.

Three-year look back exercise.
We conduct a comprehensive review of historical claims data over the past three years, identifying any missed reimbursement opportunities and correcting inaccuracies. This proactive approach ensures that no potential revenue is overlooked.

Financial reporting.
Our detailed financial reports provide insights into key metrics, including claim approval rates, denial rates, and overall revenue performance. These reports support strategic decision-making and help in assessing financial health.