Insurance Discovery Checklist: Step-by-Step Process

Office Ally represents three pillars for insurance discovery: performance, innovation, and the highest value for our customers. Our team delivers the most experience in the industry to create a product with the most sophisticated algorithms. The result is creating the most efficient process your revenue cycle team has ever seen.

Our Insurance Discovery tool drives efficiency within your revenue cycle team. It creates customized workflows and reporting that improve your process. Are you interested in  Insurance Discovery for your organization? The seven-step process for incorporating our tool into your daily operations is simple.

1. Sign Our Business Associate Agreement (BAA)

We start with a free assessment to prove our Insurance Discovery concept will yield returns for your business. First, sign our Business Associate Agreement. This states that Office Ally and the provider will always maintain regulatory compliance. These regulations protect patient data and cover the general legalities of the relationship.

Ensure Compliance with HIPAA & Other Regulations

We work with you immediately to set up a HIPAA-compliant web portal or secure file transfer protocol (SFTP). Even a free assessment requires the utmost security and protection of patient data. 

Provide Initial Assessment Data File to Office Ally

Deliver the initial free assessment data file, preferably in a .CSV or .XLS format. Don't worry if neither of these formats is compatible with your process. Our system can ingest any file format (including .TXT) as long as critical data elements are present. You can usually extract all data fields from an A/R file. In most instances, you can seamlessly use existing file extracts.

Required data for optimal revenue recovery includes:

• Provider NPI
• Patient account number
• Name
• Date of birth
• Gender
• Admit date
• Discharge date
• Zip code
• Total charges

Additional optional data fields include patient address, patient type, and social security number. This first step takes, on average, around five days but only requires two to four hours of staff time.

2. Review Assessment Results

Within 7-10 days, Office Ally will deliver the results of your initial assessment for your team’s review.

Check Provided Assessment Results

Review the assessment and note which accounts now have identified sources of billable coverage. Remember, this assessment is 100% contingency-fee-based and risk-free. There are no activation or setup costs. The provider only pays upon success.

This is a win-win opportunity. Providers receive a free audit by an industry leader to verify their existing workflow. Or vendors perform at the highest level. Otherwise, Office Ally finds other revenue opportunities and prevents further leakage.

Sign a Contract with Office Ally

Let's say your team is happy with the initial assessment results. If you wish to implement Office Ally’s  Insurance Discovery tool, our team will send over a contract. Then, we'll finalize the implementation.

3. Set Up Data Submission Schedule

Start an ongoing relationship by setting up a timeline for regular data file submission to Office Ally for processing. 

Establish Timeline for Data File Submission to Office Ally

Office Ally will work with you to create a simple, repeatable process for sharing the required patient data. This process will require minimal effort on yours part. Repeat initial assessment data sharing guidelines mentioned in step one for each data file submission.

Data is Processed

Our technology, algorithms and infrastructure allow us to process large data files. We do this with pinpoint accuracy and lightning expediency. Our comprehensive payer search covers Medicaid, Medicare (including Managed Care) and commercial payers. Multi-use algorithms handle various complexities. These include insurance verification, dual eligibles, zero balance and coordination of benefits.

4. Receive Results from Office Ally

Within 7-10 days after each submission, a detailed assessment report will be returned to validate the quality of our findings. Our quick turnaround time and the quality of results maximize your revenue recovery dollars. At the same time, these features drive efficiency in your claims submission process. 

Results Returned to Your Team for Review

 Office Ally’s Insurance Discovery includes a user-friendly summary of findings. You'll also receive detailed, customized information based on the type of coverage found. As with the initial assessment, take a moment to review these results.

5. Review and Bill Eligible Claims

Office Ally’s Insurance Discovery solution's technology examines eligible claims, not eligible individuals. The tool returns reports containing only eligible active coverage on date of service accounts. Other services only focus on quantity over quality of results.

Use the Results Report to Find Newly Eligible Claims

Office Ally discovers eligible claim coverage and returns a file showing which claims to bill.

Bill New Eligible Claims

Our comprehensive and customizable reporting delivers actionable details for submitting patient claims. Your report format gives you all the information you need to bill claims as your next step in recovering payment. You’ll know what is likely to get paid and what isn’t, and you'll be able to prioritize billing accordingly.

6. Adjudicate and Verify Claims

Once you have billed the necessary payers, you’ll share this information with Office Ally.

Send Adjudicated Claims to Office Ally

You’ll let our team know which accounts were found to have active, billable insurance coverage. Once these claims are adjudicated, send Office Ally a list of any that were successfully billed and for the paid amount. Office Ally will verify the information before invoicing you.

Office Ally Verifies Claims Before Invoicing Your Organization

Office Ally uses a full “at-risk” model. Contingency fees are based on our ability to find valid claims with previously unknown coverage. This is the industry’s most comprehensive revenue recovery model, with guaranteed results.

7. Ongoing Consultation and Workflow Updates

This process, detailed in steps 3-6, is repeated at an agreed-upon frequency. We receive the data file, create a results report, identify claims to bill, reconcile payments, and rinse and repeat. We’re your partner every step of the way. We ensure the best performance and continuous technological evolution. It's the only way to keep up with an ever-changing industry.

Office Ally Provides Ongoing Consultative Reviews

We will continue to consult, providing your organization with the best insurance discovery partnership. We will also check in regularly to ensure your team is satisfied with the service and performance they receive.  

Update Workflows to Match Your Organization’s Needs

As the industry grows and evolves, we expect providers’ needs to change along with it. We continuously update workflows and reports to meet these needs. There are no additional fees for custom reports or configuration.

Get started today with your free, no-risk Insurance Discovery assessment from Office Ally. Click here for more information.