Credentialing & Medical Billing for U.S. Providers
Credentialing & Medical Billing for U.S. Providers
Most claim problems begin long before a claim is sent. An inactive policy, a missed referral, or a procedure that needed prior approval can turn a completed visit into unpaid work. Practices lose time and revenue chasing answers from insurance companies instead of caring for patients.
Alpha RCM Solutions takes the insurance side of your revenue cycle off your front desk. We verify coverage and benefits before the visit, secure authorizations and referrals, and follow up with payers until the matter is resolved, so every claim leaves your office with the right information behind it.
Talk to an insurance specialist:
From the moment a patient books an appointment to the day the payer pays, our team manages the insurance work that keeps your cash flow steady.
We confirm active coverage, deductibles, copays, coinsurance and plan limits before the patient arrives, so your team knows what to collect and what the plan covers.
We identify which services need approval, prepare and submit the requests with supporting documentation, and track each one to a decision before the date of service.
Being in network matters. We help providers get enrolled and credentialed with insurance plans so patients can use their coverage and claims are paid at contracted rates.
We check claim status directly with insurance companies, answer requests for records, and keep unpaid claims moving instead of letting them age in accounts receivable.
When an insurance company denies or underpays a claim, we find the reason, correct what can be corrected, and file appeals with the documentation the payer requires.
Insurance policies change often. We keep track of payer rule updates and report on authorizations, denials and payer turnaround so you can see what is affecting your revenue.
Catching an eligibility or authorization issue before the visit costs a phone call. Catching it after a denial costs weeks of rework. Let our team handle the insurance work up front.
A simple, repeatable workflow that fits into your existing schedule and billing system.
01
We learn your payer mix, specialties and scheduling workflow, then agree on how patient and insurance data will reach us.
02
Before each scheduled visit we check eligibility and benefits and flag inactive plans, coverage gaps and patient responsibility.
03
We request prior authorizations and referrals, attach the clinical details payers ask for, and track each request until a decision is issued.
04
We monitor submitted claims, contact insurance companies about delays, and work denials and underpayments through correction or appeal.
05
You get regular reports on authorizations, denial reasons and payer response times, so recurring problems can be fixed at the source.
Insurance work is repetitive, deadline-driven and easy to put off when the waiting room is full. A dedicated team gives it consistent attention, so your staff can focus on patients.
We handle verification, authorization and follow-up across government and commercial plans, including regional and specialty carriers.
Medicare
Medicaid
Blue Cross Blue Shield
Aetna
Cigna
Humana
UnitedHealthcare
Regional & Commercial Plans
It is the check that confirms a patient has active coverage on the date of service and shows what the plan pays for, including deductibles, copays, coinsurance and any limits. Doing it before the visit prevents surprise denials and helps your team collect the right amount from the patient.
It depends on the insurance company and the plan. Imaging, surgery, specialty referrals, therapy visits and some medications are common examples. We check each plan’s current requirements for the service being scheduled and submit the request when one is needed.
Yes. We work inside the systems and payer portals your practice already uses, so there is no need to change your software or your schedule to get started.
Yes. Insurance support connects directly with our medical credentialing, medical billing and denial management services, so one team can follow a patient’s claim from enrollment to payment.
Tell us about your practice and the plans you bill most. We will show you how our team can take verification, authorizations and payer follow-up off your plate.
