Resources
We specialize in managing and resolving complex insurance claims for healthcare providers and health systems nationwide. Our expertise spans commercial and government payers, ensuring providers recover the reimbursements they are entitled to, even for the most challenging or aged claims. By navigating regulatory frameworks and payer-specific processes, we help streamline claim resolution and maximize revenue recovery for our clients.
Veterans Administration
With the implementation of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (“MISSION”) Act, the VA restructured and streamlined its authorization processes to improve access to care for Veterans. Simultaneously, the launch of the Community Care Network (“CCN”) introduced enhancements to the notification system for emergency care, ensuring a more efficient and coordinated approach. Although these processes are widely recognized within the healthcare community, the VA employs them in distinct ways. So, what exactly is the difference between VA notifications and authorizations? Let’s break down how each process functions and what it means for managing your Veteran population effectively.
Worker's Compensation
Getting out-of-state Medicaid claims paid requires specialized expertise and knowledge of each state’s billing procedures. Without the right team, many claims go unpaid, forcing providers to write them off, which negatively impacts finances. Success in out-of-state billing involves enrolling your facility and physicians in the required programs, using accurate billing codes, keeping provider numbers up to date, verifying patient eligibility, and securing prior authorization when needed. Leveraging technology for compliance checks and consulting with Medicaid experts for complex cases can also make a difference. Given the complexity of the process, healthcare organizations that enlist experts will have an advantage in maximizing reimbursement.
Filing workers’ compensation claims can be a complex process for healthcare providers, particularly due to the varying regulations across states. We frequently receive questions regarding important aspects of this process. Providers often want to know how much time they have to file the initial bill and appeal, how reimbursement is calculated for inpatient and outpatient services, and how payers handle reimbursements for out-of-state patients. Additionally, many ask how much time the payer has to issue payment. To help you navigate these questions, take a look at our interactive map for the information you need to get started.
Out-of-State Medicaid
Motor Vehicle Accidents
Navigating MVA claims is a complex task for healthcare organizations, as it involves multiple parties, varying insurance policies, and serious injuries requiring long-term treatment. The process is further complicated by state-specific laws, extensive documentation requirements, and the need to coordinate with healthcare providers and specialists. Skilled negotiation is essential when dealing with insurance companies that may attempt to deny or minimize payouts. Additionally, submitting claims and supporting documents accurately and on time, while following up until resolution, is crucial to the success of the claim.
As a new client, you’ve already experienced smooth integration with our Implementation Team, which is giving you greater control over your revenue from complex claims. But that’s just the start.
When you partner with ZoMedica, you also gain access to our Client Engagement Team—an experienced group of experts committed to your ongoing success.
More Than Just a Vendor
We see ourselves as an extension of your team, not just a vendor. One of the greatest compliments we often receive is, “You get us.” Our Client Engagement Team understands your business’s unique needs and, with a focus on flexibility and solutions, helps you navigate the complexities of handling claims.
We’re a vital part of your success, offering strategic action plans, monthly reporting, regular business reviews, high-level advisement, and consistent, day-to-day engagement and support—so you can stay focused on what you do best.