Custom Built No-Fault Billing & Collection Software

Medical billing software is the most important tool in any healthcare provider’s practice. The choice of having the perfect medical billing software is even more important when a practice deals with no-fault medical billing.

At the time we decided to go in the no-fault billing business, we searched endlessly, interviewed hundreds of medical billing software companies, patiently sat through countless demonstrations, and heard many promises of rich features, but we couldn’t find a single software that was good enough or specifically designed for no-fault billing.

After spending about 6 months in search of the “right” medical billing software, it became clear that software designed specifically for no-fault billing just did NOT exist.

We couldn’t find any medical billing software that could understand The New York State no-fault insurance laws. All medical billing softwares being sold in USA are designed to do billing for Major Medical, Medicare and Medicaid. They certainly do not understand the laws that govern the NYS no-fault insurance.

Theoretically, almost any “out of the box” medical billing software could be modified or tweaked to entertain no-fault billing. However, no matter how much we tried, none of the softwares could truly handle the complexities of no-fault billing & collection.

We decided to create a no-fault medical billing software from ground up. A unique, customized medical billing software that understands the intricacies of New York State No-Fault law and the complexities of no-fault billing & Collection processes.  To complete this task, it took incredible cross-collaborative efforts throughout not only the IT industry, but also the healthcare and legal industries.

We hired the top software engineers, collaborated with the top IT companies, and consulted with the best no-fault collections attorneys in the industry.  As a result, we created a customized no-fault billing and collection software. This is not just a medical billing software, rather a no-fault collection’s software which incorporates the no-fault billing processes to ensure highest recovery results.

No Fault Billing & Collection Services

No Fault Billing

Step 1 of No-Fault Billing: Producing No-Fault Bills

Physicians have 45 days from the date of treatment to produce and submit no-fault medical bills to insurance companies. According to the current No-Fault Insurance regulations, all no-fault medical treatment bills must be created on the prescribed No-Fault Verification of Treatment Form (“NF-3”). Office-based surgery centers and/or Article 28 facility bills must be submitted on the UB-04.

We produce most no-fault bills using the NF-3.  No-fault medical bills are produced on a daily basis, based on the treatment rendered by the physician. To ensure that all no-fault medical bills are produced and submitted within 45 days of each date of service, our no-fault billing software is programmed to follow a 30-day rule. This provides a 15-day window to address unforeseen circumstances, and ensures that no-fault bills are never submitted late.

Step 2 of No-Fault Billing: No-Fault Bills Review Process

No-Fault bills are created on a daily basis and queued in a “Review Folder.” Physicians can access the bills online using an encrypted connection, which allows them to review and sign the bills and then release them for printing. Most physicians using our no-fault billing service do this on a weekly basis.

Once the physician reviews the claims, the claims are queued for printing. We then make sure that all necessary notes—for example, trigger point injection and physical therapy notes—are attached to the bills and signed. All NF-3s are printed and are grouped by individual insurance companies.

No Fault Proof of Mail

Many physicians believe that since they are using an electronic medical records (“EMR”) software of some sort, they are and should be 100% paperless. Although this may be the case with most medical insurance companies, this is NOT the case for no-fault insurance companies in The State of New York.  No-fault insurance companies require that ALL no-fault bills must be printed and submitted using an NF-3 Form.

All no-fault medical bills require proof of mailing. The burden is on the physician to prove that his or her no-fault medical bills were produced and mailed within 45 days of the date of treatment.

When the time came to build the “MAIL” feature of our no-fault billing software—one that would generate a solid court-accepted proof of mailwe left no stone unturned.We steered away from old methods like the use of a mailing book and registered mail with return receipt requested.  Instead, we built a highly efficient and effective proof of mail system.

We built a customized shipping software, utilizing the laser barcode system, that works in conjunction with each no-fault bill generated by us and matches it with the priority mail serial number from the United States Postal Service upon delivery.

A Brief Description of Our No-Fault Mailing Software

Our customized no-fault mailing feature provides proof of mail as well as proof of delivery for each and every single bill produced and mailed by us.

Unique Serial Number: As each bill is created it gets assigned a unique serial number. This is a unique identifier that helps track each bill within our billing system at any given stage. Each bill gets queued for printing within its assigned folder, that folder then gets assigned a United States Postal Service’s Priority Mail tracking number.

United States Postal Service’s Priority Mail Service: As bills from each folder are  printed,  they are matched with United States Postal Service’s Priority Mail Label, combining the unique serial number and United States Postal Service’s Priority Mail tracking number.

All bills are then asserted in the priority mail envelope and mailed to the insurance carrier. Upon delivery, our no-fault billing system’s shipping software works directly with United States Postal Service’s Priority Mail Service, to retrieve the proof of delivery. The entire process is automated and seamlessly integrated into our no-fault billing system.

This produces the most powerful Proof of Mail and Proof of Delivery, a signed document, on United States Postal Service Letterhead, confirming the delivery of a specified piece of mail. The receipt includes the time at which the insurance company received the mail, the name and signature of the person who received the mail.  The mailing receipt also includes a tracking number assigned by the U.S. Postal Service.  This tracking number syncs directly into our no-fault billing software. The software automatically links the tracking number to all the sent claims in that folder, and to the first and last dates of service indicated on that claim.

Our proof of mail and proof of delivery includes the following information:

  1. Patient’s name.
  2. Dates of treatment that were billed and mailed.
  3. Billed amount.
  4. Address of the insurance company or claims office that the bills were mailed to.
  5. Insurance company’s claim number.
  6. Date the bills were mailed.
  7. Name and Signature of the a person who received the bills at the insurance company.
  8. Time and date at which those bills were received.
  9. Tracking number linked to each individual bill.

We are experts in no-fault billing and collection.  For more information about our state-of-the-art proof of mail system, call us at (516) 427-5400 for an immediate, free consultation.  


No Fault Verifications

The Verification Demands by No- Fault Insurance Companies

The real work of any no-fault billing company begins as the correspondence from no-fault insurance companies starts arriving in the mail on a daily basis. The rule is simple, larger the practice, the more bills it will send out to insurance companies and it will receive more correspondence demanding verifications by the insurance carriers.

No-fault Insurance companies send out a large number of verifications and demand documents pertaining to the no-fault medical bills they receive.  These requests are rarely legitimate and, in most cases, are used by insurance companies simply as a delay tactic.  As the mail starts coming in, so do the problems of handling no-fault  insurance companies’ requests and responding to them.   

No-Fault Billing Verifications Law

Effective April 1, 2013, physicians have only 120 days to respond to each verification request by an insurance company (this does not include requests for examinations). Failing to do so within 120 days will result in the complete and final denial of the entire bill.  

Once this 120-day timeline has passed and verification is still pending, no further collection method, like arbitration or litigation, can be engaged on that particular bill.  If a document is not within the custody or control of the provider, the provider must submit written proof within 120 days, stating that the document cannot be obtained or does not exist.  Failure to submit such proof will result in the complete denial of the bill.

Our No-Fault Billing Verification Process: All incoming mail from insurance companies is opened and scanned into our no-fault billing software on a daily basis.  We have a multi-step process to promptly handle all incoming mail, including the issuance of verification responses.

Step 1: Automatic Identification by Practice and Patient: In this step, the artificial intelligence built into the no-fault billing software identifies the patient and attaches each document to that exact patient’s file as it is being scanned into our billing system.  Some of the identifying characteristics used to perform this task include the patient’s name, address, policy number, claim number, date of birth, date of accident, name of the insurance company, date of service, and/or the nature of the service.

If a document is not automatically identified to be attached to the patient’s file, the document is sent to a folder called “Unidentified.” All documents in this folder are thoroughly examined, identified, and attached to the patient’s file by account executives. This process is completed within 72 hours of the arrival of mail.

Step 2: Sorting No-Fault Verifications and Demands: The documents are not only identified by practice and patient, but are also sorted according to the type of verification the insurance companies request.

This task has been accomplished by automating our no-fault billing software. Our software’s “No-Fault Verifications Library” automatically sorts about 80% of the documents scanned into the system.  Our No-Fault Verifications Library feature was built into our no-fault billing software and is updated almost on a daily basis.

The No-Fault Verifications Library is a unique and patent-pending feature custom designed by our software engineers to maintain a constant and updated database of verification requests we receive on a daily basis.  Our database contains thousand of verification requests sent by insurance companies.  Our experienced staff manages this database and has the expertise to categorize the data  in various ways to expedite responses to insurance companies.  

About 20% of the documents we receive require actual human interaction. This may be due to the fact that a particular document may not be a part of the No-Fault Verifications Library, a document has been modified by the insurance company, or a document is a brand new form of verification the insurance company has decided to request.

If there is an issue with our automated verification response system, verifications are queued in the “Live No-Fault Verification”status. Account managers, who are experts in no-fault billing, review documents queued in this status on a daily basis. As stated above, these verification requests are added and categorized in our No-Fault Verifications Library for future automation.

Step 3: Sending Verification Responses to Insurance Companies: All communication with insurance companies taking place via mail is done through our custom-designed, patent-pending proof of mail feature, with the help of the United States Postal Service’s Priority Mail system.  Verification responses sent via mail are sent through this system.

Verification responses are also sent via fax to insurance companies.  Our compiled verification responses to insurance companies consist of a cover page indicating the date and the exact documents enclosed within the verification response.  Proof of delivery also includes a fax confirmation page, which shows where the documents were sent, when they were sent, and the results of transmission.

Our No-Fault Billing system is designed to complete the verification process within 72 hours. If we are not in possession of the document or information being requested by the insurance carrier that timeline is extended to another 72 hours. Beyond that timeline system is designed to alert account executive and manager to intervene and ensure that outstanding verification request is handled efficiently.

All communication with the insurance company, throughout the life cycle of the claim is preserved with proof of mail and proof of delivery

We are specialists in no-fault billing and collection.  To learn more from us about Verification Requests, please call (516) 427-5400 for an immediate, free consultation.  


No Fault Denial Management

Our software is designed to conduct a complete No-Fault  Denial Management Function for all no fault bills submitted to insurance carriers by us. We built our no-fault billing software with denial management in mind as a key component.

All denials received are sorted and scanned into our no-fault billing software.  The scanned denials are automatically indexed into the corresponding patient’s account.  Our unique, custom-designed no fault billing software has the capability of automatically grouping the denials based on the reason or reasons for denial.Once the denials are indexed, the patient’s file is automatically moved to the Collection Status.

Collection Status: Once the file is marked in collection status, A new file is created in PDF format, which includes a copy of the bill for which the denial was issued, proof of mail & delivery, verification correspondence with the insurance company. This entire procedure is automated to prevent any further delay in pursuing a collection’s option, Arbitration or Litigation.

The file is then immediately emailed to the healthcare provider’s attorney. Once a collection attorney has been retained by the healthcare provider his/her information is programmed into our billing system to ensure that all files are delivered automatically without any delay.

Our custom no fault billing software keeps a complete accounting of all files delivered to the healthcare provider’s attorney.  We are fully capable to deliver a complete collection ready file to any attorney in any preferred electronic method.

Actual Denial Management: Following in a description of our no-fault denial management processes.

Step 1: Separation by Reason: All denials are separated by their individual reason. Following are some of the most commonly issued denials by the insurer carriers.

Step 2: Action required: After the denials are separated by type and scanned into the system, within 72 hours they have to be addressed. The 72 hour requirement is a built in feature in our no-fault denial management system, ensuring zero lag time.

Please take a moment to read through some common reasons used by insurance carriers and actions taken by us. 

1, “IME” Cut Off: This type of denial is issued upon the recommendation of the IME physician, usually based on medical necessity.

Our Action: We retrieve all treatment notes / supporting medical necessity documents and attach them to this type of denial and move the file in collection ready status. This file is now ready to for arbitration or litigation. This file will automatically be moved to the physician's attorney for collection. Attorney will get the file within 72 hours, preventing any lag time.

2, IME no Show: This type of denial is issued when the patient does not show up to a scheduled IME. This is a Policy Violation Denial.

Our Action: We handle IME No-Show denials in four steps

1, Inform the treating physician immediately that patient has violated the policy provision and assignment of benifit may not be good anymore.

2, Call the patient’s Personal Injury Attorney to confirm that his client has in fact violated a policy provision by not showing up for an IME, or is there a second IME scheduled?

If The second IME has been scheduled by the insurance carrier we will move the file to collection ready status based on frivolous denial. There are times where patient has shown up for an IME and insurance carrier still issued a denial based in IME No-Show, such denials are also marked as frivolous and file is moved to collection ready status.

However if it is establish that the patient has in fact not shown up for IME for two times or more and the policy provision has been violated, the entire file is converted to a LIEN status. As the assignment of benefit is no longer valid. In this scenario, we immediately secure a lien on patient’s file through his personal injury attorney and notify the treating physician of the current status.

3, Unnecessary Medical Treatment: This type of denial is issued by the insurance carriers challenging the medical treatment of the treating physician. This is also a medical necessity Denial.

Our Action: We retrieve all treatment notes / supporting medical necessity documents and attach them to this type of denial and move the file in collection ready status. This file is now ready to for arbitration or litigation. This file will automatically be moved to the physician's attorney for collection. Attorney will get the file within 72 hours, preventing any lag time.

4, Policy Exhaustion: This type of denial is issued by the insurance company when they are claiming that the insurance policy has been exhausted and no more funds are available to provide coverage. This denial is categorized as a technical denial.

Our Action: In this particular case we demand from the insurance carrier to prove that there infact has been policy exhaustion. We immediately secure a lien on patient’s file through his personal injury attorney and notify the treating physician of the current status.

5, Fee Schedule: Insurance companies often take position that the fee schedule billed for a particular treatment was not correct.

Our Action:  85% of the time insurance carriers are wrong and that denial is frivolous. We attach the necessary fee schedule documentation and or affidavit, as needed and  file will automatically be moved to the physician's attorney for collection. Attorney will get the file within 72 hours, preventing any lag time.

6,Late Submission Denial: The bill or bills were not timely submitted within 45 days of their respective date or dates of service.

Our Action: Using our customized mailing software, each bill is submitted to insurance carriers through United State Postal Service Priority Mail, providing a solid, no nonsense proof of mail and proof of delivery within 45 days from the date of service.  We attach the proof of mail and proof of delivery to these denials and bring the file to collection ready status, this file will automatically be moved to the physician's attorney for collection. Attorney will get the file within 72 hours, preventing any lag time.

We are experts in No fault billing and collection, hence each billing file is prepared with the no-fault collection’s process in mind. Our customized no-fault billing software is designed to keep all documents in an itemized and indexed format. If a claim has received a denial , our no fault billing system will automatically move it to collection stage. A complete “Collection Ready” file  will be delivered to physician’s attorney, via email, FTP, and or any other preferred method. This process is fully automated.

Collection Ready File, file delivered to the physician’s attorney typically has the following items:

1, Assignment of Benefit

2, NF-3, The actual No-Fault Bill

3, The physician’s report

4, Medical reports or supporting medical documents

5, Proof of mail

6, Proof of delivery

7, All correspondence with the insurance company  (verifications)

8, Proof of mail & delivery for all verifications

9, The actual Denial  

We specialize in no-fault billing and collection.  To learn more from us about no-fault denial management, please call (516) 427-5400 for an immediate, free consultation.