Reimbursement
Claims & A/R Administration
Payer-facing claim status, aging accounts-receivable follow-up, and payment-variance investigation and recovery support, documented through the payer workflow.
Overview
Once a claim has been submitted, getting it adjudicated correctly is payer-facing work: finding out where it stands, supplying what the payer says is missing, resolving administrative holds and coordination-of-benefits questions, pursuing claims that have stalled, and identifying claims that paid at zero or below the contracted amount. That work competes for the attention of billing staff who also have charge entry, coding, and patient balances to manage.
PriorDesk takes ownership of the payer-facing side. We research claim status through payer portals and telephone follow-up, work pending, stalled, and aging claims, resolve missing-information requests and coordinate medical-record requests, manage payer correspondence and escalation, and follow reprocessing requests and payer commitments through to the payer’s final determination. Zero-pay claims, underpayments, and contract or payment variances are identified and pursued with the payer through its reprocessing and dispute processes; recoupments and takebacks are researched and responses coordinated. Whether a variance is recovered is decided by the payer. Corrected claims and resubmissions are coordinated when the practice or its billing system supplies the corrected billing information. Aging and payer trend reporting shows where the receivable is concentrated and why.
What PriorDesk handles
Claim status and follow-up
- Claim-status research through payer portals and payer telephone follow-up
- Pending, stalled, and unprocessed claim follow-up
- Aging accounts-receivable follow-up
- Missing-information resolution and medical-record request coordination
- Payer correspondence and payer escalation
- Administrative hold and coordination-of-benefits follow-up
- Reprocessing-request follow-up
- Tracking payer commitments through the payer’s final determination
Payment variance and recovery support
- Zero-pay claim investigation
- Underpayment and contract or payment variance identification
- Underpayment recovery follow-up with the payer
- Recoupment and takeback research and response coordination
- Corrected-claim and resubmission coordination when corrected billing information is supplied
- Aging reporting and payer trend reporting
Where it sits in payer administration
Claims and A/R work relies on the eligibility, referral, and authorization record established ahead of the visit, and hands off to denials and appeals when a payer’s adverse decision requires a formal response. For billing companies, it is the payer-facing layer that complements charge entry, coding, and patient billing.
Within your existing systems
PriorDesk performs this work inside the systems your practice authorizes for the assigned workflow: the EHR or practice-management system, payer portals, pharmacy benefit manager and specialty-pharmacy platforms, clearinghouses, CAQH and PECOS, and the payer telephone channels the work requires.
Your practice provisions the accounts, sets the permissions, and can modify or revoke access at any time. Nothing is moved into a separate PriorDesk patient database.
Reporting and accountability
PriorDesk documents payer activity within the practice-approved systems used for the engagement, with supplemental operational tracking where appropriate. That tracking is aggregate and contains no protected health information; patient-level case detail stays in your systems.
Reporting appropriate to the engagement covers case status, last payer action, next follow-up, deadlines, determinations, unresolved issues and escalations, and the administrative barriers that recur.
Service boundaries
PriorDesk is not a medical billing company. Claims & A/R Administration does not include:
- Medical coding or coding review
- Charge entry or routine claim creation
- Full-service medical billing
- Patient collections or patient statement processing
- Patient balance inquiries
The practice or its billing organization retains the billing system, the coding function, and the patient financial relationship. PriorDesk complements that operation rather than replacing it.
When work is scoped separately
Routine claim follow-up is included in the Claims & A/R Desk and the Payer Desk plans. Scoped separately as projects:
- Underpayment recovery follow-up across a defined date range or payer
- Recoupment and takeback response projects
- Aged accounts-receivable clean-up of a legacy receivable
- Payer-specific escalation programs
- Volume above the published plan tiers
Specialties where this work is concentrated
Get started with PriorDesk
Tell us about your practice, your approximate monthly volume, and the support you need. We review your workflow, confirm the scope, and send the agreement and onboarding documents. No patient information is requested or accepted.