Anew Treatment Center has partnered with a seasoned, reputable third-party insurance verifier, SJ Health Insurance Advocates (SJHIA), who along with their team of data analysts and developers will help our clients maximize the benefits they are entitled to.
Here’s a brief summary of the services they will provide our families:
Verification of Benefits
SJHIA works with treatment centers and clients to verify and understand their benefits as it relates to the specific treatment service being provided. They have a dedicated team of professionals who will verify benefits by completing a thorough inquiry with the insurance company and detailing this information in an individualized template. SJHIA will also work with clients by understanding their benefits, their expected reimbursement, and the specifications of their policy. For years, SJHIA’s thorough and timely approach to verifying benefits has been a financial boon to families seeking reimbursement.
Insurance companies are sometimes complicated and frustrating organizations to deal with. We have hired SJHIA to, among other things, complete appeals when necessary on behalf of our families. This may occur if treatment was never authorized, or if treatment was denied somewhere in the authorization process. SJHIA will comprehensively evaluate your case, including but not limited to reviewing your medical records, in order to determine which appeal options may be the best fit. SJHIA employs fully licensed therapists with extensive experience navigating the appeals process in order to advocate on behalf of the client.
Insurance companies may begin to deny authorization at some point in the treatment process. SJHIA’s competent and fully licensed therapists advocate for additional approvals by completing a “doc-to-doc” or “peer review” with the insurance company doctors. SJHIA is able to complete these reviews on behalf of the treatment provider due to the expertise and licensure of their staff.
SJHIA continues to seek authorization and reimbursement throughout the duration of treatment. This includes concurrent reviews with the insurance company to continue to prove medical necessity for the level of care being rendered. These reviews are also completed by fully licensed therapists who utilize their strong clinical backgrounds to advocate for the client’s treatment.
SJHIA works to diligently generate and submit claims, as well as track them throughout the entire process. SJHIA identifies issues immediately and works to resolve them in a timely fashion in order to have claims processed and paid as quickly as possible. Unique to SJHIA, they utilize software that allows for complete transparency and accountability in this process. Their billing software allows treatment providers to see exactly where and how claims are being processed and the work being done to have these claims paid. There is a dedicated team that works specifically with you; understanding the nuances of your claims, customizing reports designed specifically for you, and succeeding in maximizing your revenue.
Pre-Authorization of Services
Entering treatment can often be a difficult and overwhelming experience. SJHIA works with Anew to reduce any additional stress that may come from seeking authorizations and reimbursement. SJHIA completes initial authorization requests with insurance companies in a thorough and timely manner in order to set clients up for reimbursement success. Competent, fully licensed staff complete the initial authorization request to prove medical necessity for the specific treatment being rendered. SJHIA maintains consistent and timely communication with both Anew and our families to make the process as seamless as possible.
Most revenue cycle management companies accept whatever payment an insurance carrier will pay and then close the claim. SJ Health Insurance Advocates has a dedicated team of quality assurance representatives that take the claim adjudication process many steps further.
After all claims are adjudicated, SJHIA has thirteen additional steps taken to ensure all claims are adjudicated in line with the maximum reimbursement allowed per your insurance policy. SJHIA has built a sophisticated reporting suite designed to scrub each claim looking for anomalies in reimbursement. When such anomalies are found, the QA Team gets an alert to review the specific claim in greater detail. This due diligence lends itself to higher reimbursement for services and a happier client for Anew.