Frequently Asked QuestionsFAQ
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Insurance Billing FAQs
Does RevCycle review claims prior to submission?
RevCycle will review claims prior to submission. Some examples of things your biller will look at: adding necessary modifiers, diagnosis for medical necessity based on service code and payer, and cataract co-manage claims for surgeon information and billing details.
How does RevCycle handle transfers?
RevCycle will transfer necessary patient responsibility based on insurance processing: deductibles, co-insurance and copays RevCycle will provide as much detail as possible using transfer reasons to describe why a transfer was done and why a patient may owe you money.
What if a claim is denied?
If a claim is denied due to eligibility, RevCycle will look for current coverage in the patient chart, family member charts, and/or insurance websites if available. If no new coverage is found, your biller will transfer the balance to the patient.
Can RevCycle Partners verify medical and vision benefits for patients?
RevCycle Partners does not verify patient benefits or eligibility. RevCycle Partners also does not attain authorizations or fee schedules for insurance plans. Those responsibilities would remain at the office.
How many times and for how long will RevCycle Partners attempt to get a claim paid?
RevCycle Partners will exhaust all avenues available to get a claim paid, including filing appeals, chasing denials, and refiling claims.
What are the terms of the contract?
With RevCycle Partners there is no long-term contract. Our service is a month-to-month commitment with a $500/month minimum. We require a 60-day termination notice.
Sometimes my staff forgets to add a procedure performed such as a visual field, is this something RevCycle Partners checks for?
No. That is the responsibility of the doctor or office to make sure all services that are performed are coded and applied to an invoice. RevCycle Partners asks that the office verify this as well as make sure that there is a diagnosis on the claim prior to authorizing it. RevCycle Partners will submit corrected claims if something was missed.
Does RevCycle Partners handle patient questions?
There is a relationship between the office and a patient that RevCycle Partners is not familiar with. Our team doesn't want to risk causing any issues for the office or the patient. If the office has a question about a patient balance, they can send their biller a message and/or call. We are happy to provide further details to help explain why the balance is owed.
I still receive EOB’s in the mail. How does RevCycle Partners post those?
For items received in office, we ask that those be scanned to a designated area within your system for review by your biller. This can include EOB’s, checks, and requests for records.
Do you require a contract for your Managed Services offering?
Yes. RevCycle Partners requires a two-year agreement for its ongoing credentialing offering called "Managed Services."
What is the difference between in and out of network.
In network means the health care provider has contracted with an insurance plan and approved services are paid according to the contracted fee schedule. Out of network means the health care provider is not contracted with an insurance plan, and benefits will generally process under out of network benefits. This usually means higher out of pocket expenses for the patient.
What is CAQH and do I have to have it?
It is the Council for Affordable Quality Healthcare. Yes, you must have a CAQH. A majority of the insurance companies use CAQH to confirm information that has been provided to them.
Why do you need my CAQH and PECOS information?
RevCycle Partners will verify and update information as required throughout the credentialing process. Having CAQH and PECOS access reduces paperwork and ensures timely receipt of information.
What happens if I don’t want to provide my CAQH and PECOS login information?
You will be required to fill out a CAQH equivalent paper universal enrollment application and we will submit to process your enrollment. Any insurance plan that does not allow paper submission will result in a denial of participation and you will be required to pay for a new application submission via CAQH. PECOS is for Medicare application and processes quicker online than on paper.
What happens if I don’t want to provide my CAQH?
You will be required to complete a paper version of the CAQH enrollment application. We will submit this based on your service order. Some insurance plans do not accept paper applications and are required to be filed electronically. PECOS is for your Medicare application, and online submission is recommended for timely processing of this application.
What happens if I don’t submit all my information?
We ask that all necessary documentation is received within 14 business days to avoid cancellation of your order..
What happens if the networks are closed and/or request for participation is denied?
Depending on the reason for denial, RevCycle Partners will submit an appeal and/or request participation again for a period of up to six months from time of denial.
Am I responsible for payment if my application is denied?
Yes. RevCycle Partners has verified your information and completed and filed the necessary paperwork on your behalf. We cannot guarantee acceptance. That is solely up to the insurance company to determine.
Once I am credentialed, am I in network for that insurance?
No. For many insurances, being credentialed means you can see patients, but it will pay as out of network.
What is the difference between credentialing and contracted?
Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy. Credentialing is required for most insurance companies to be contracted. Contracted means you are an in-network provider and have a signed agreement to accept patients for an agreed fee for service.
Does RevCycle Partners credentialing negotiate the fee schedule for me or provide me with a copy of it?
How often will I get an update from you regarding my status?
RevCycle Partners will update information as it’s received from the insurance company. You can login to your portal account to access any updates noted at any time. RevCycle Partners tries to update information every 21-30 days. Any delays in updates will be communicated.
What happens if the insurance sends me something or reaches out to me?
If the insurance reaches out to you or sends you any documentation, it is imperative that you notify a credentialing team member immediately. Failure to forward information from the insurance causes delays. It can also mean having to start the application process over, resulting in new fees being charged to you.
How long will credentialing take?
Generally, credentialing can take up to 120 days. Contracting can take an additional 60 days. There are variations in time depending on insurance and reasoning, it can mean shorter and/or longer time frames.
What if I have a part-time doctor?
All doctors expecting to receive reassignment of benefits as a participating provider for claims, must be contracted with the insurance plan, and therefore require credentialing. The amount of time or hours the provider works is not applicable to this requirement.
What if I am already credentialed at another location I work?
All credentialing and contracting with RevCycle Partners goes through the same process, regardless of any previous credentialing or contracting that a provider may have already. The current contracting you have is only relevant to the current place you are practicing. Sometimes this is helpful when you have recently been credentialed and an insurance only has to complete the contracting portion of the provider enrollment.
How many people in the office should be a contact person?
We strongly recommend that only one person be the contact for anything credentialing related.
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“We could not be happier with RevCycle Partners. Our biller doesn't miss a thing. We were leary after a horrible experience with another billing company, but we are thrilled with RevCycle Partners!”Katy Baldry, Office Manager, Sanderson Eye Clinic