OPTOMETRIC BILLING & CONSULTING SERVICES
Claims Processing • Medicare Eligibility • Expert Consulting • Credentialing
PEN’s Optometric Billing Specialists help you achieve more revenue using less staff time.
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Fewer denials guaranteed and volume discounts.
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Eliminate hassle by verifying patients'
insurance, upfront.
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If we don't have the answer,
we know how to find it.
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Let us fill out all the paperwork, negotiate fees,
and track the process!
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Claims Processing
Claim Submission
Fast, efficient electronic claim submission in a HIPAA compliant format.
Claim Auditing
PEN reviews each claim before submission for errors that will cause your claim to be denied or underpaid. If an error is identified your claim will be returned to you for correction with specific notation on how to correct the error. Clearinghouses will not identify when a claim will be denied for issues that are specific to optometry.
Denial Resolution
PEN will research denials for you, make any necessary corrections to your claim, and resubmit it at no extra charge. Clearinghouses are not available to research denials. They are used for claim submission only and may charge you for claim resubmissions.
Consultation
PEN’s knowledgeable staff is available to answer your questions regarding claim coding, CPT and ICD descriptions, modifier usage, insurance policy, denials, and much more.
Save Time Use PEN’s Simplified Claim Form for both services & materials.
Reports
Receive a monthly report of claims submitted and claims on hold (waiting for error correction).
Pricing:
PEN Member $50 set-up fee (one time only); $2.75 per claim
Non-Member $100 set-up fee (one time only); $2.95 per claim
$15 monthly flat rate if less than five claims are submitted per month.
Note: For billing purposes, claims for services and materials are considered separate claims.
Quantity Discounts 50-74 claims earns a 5% discount
75-99 claims earns a 10% discount
100 or more claims earns a 15% discount
Note: Qualifying monthly quantities subject to change.
Medicare Eligibility Inquiry
Know in advance if your patient has signed over their Medicare* benefits to an HMO or indemnity plan. Then, if you are not on their insruance plan you can inform the patient before services are rendered that they may be held financially responsible for payment.
Avoid unnecessary denials by submitting the claim to the correct insurance the first time.
*Patients may retain their Medicare card showing eligibility even after signing over their benefits.
Pricing:
PEN Member $.50 per inquiry
Non-Member $.75 per inquiry
Expert Consulting
The Quickest Response to Your Optometric Insurance Billing Questions
Save Time - PEN will consult with your carrier for you.
Don’t wait on hold for extended periods of time. We are available to give you the answers you need.
Improve Cash Flow
PEN can show you how to bill claims specific to optometry for maximum reimbursement, including co-management and materials after cataract surgery.
PEN will help you with ICD and CPT codes, Modifiers, and payable codes to ensure proper usage and avoid claim denials.
You will receive notifications regarding changes in Medicare policy that may affect your claim reimbursements.
Information Resources
You will receive PEN’s bi-monthly newsletter with Optometric Billing & Consulting tips as well as other information that will improve the success of your practice.
The program includes Medicare contact/resource information that will route you to the right department(s).
PEN will answer your questions on general insurance and Medicare policy to help insure that you maintain compliancy in your practice.
Note: Consulting Services does not research specific claims. If you require such service, please consider our Claim Processing Service, which includes claim submission and research, as well as Consulting Services.
Pricing:
PEN Member $29.99 per month
$161.95 for six months…saves 10%
$269.91 for 12 months…saves 25%
Non-Member $39.99 per month
$215.95 for six months…saves 10%
$359.91 for 12 months…saves 25%
Credentialing - Coming Soon!
Don’t invest 6-9 months of precious staff time…PEN understands the “ins & outs” of paneling with insurance carriers (credentialing & contracting) and can do the work for you!
All you have to do:
1. Fill out one master form, instead of a different application for each carrier.
2. Choose from a list of the most requested insurances you wish to be paneled with.
PEN does the rest:
3. Creates an application packet for each insurance carrier by properly completing all applications and assembling all pertinent documentation.
4. Reviews and submits your application packet to the insurance carriers you requested.
5. Tracks the process and follows up until a resolution has been reached.
Fees to be determined.