Insurance & Payer Services
From upfront eligibility verification to clean claim submission, certified coding, aggressive appeals, and aged A/R recovery — we manage the complete payer revenue cycle. Our certified billing specialists eliminate costly denial bottlenecks and accelerate reimbursement with a 98%+ first-pass clean claim rate, securing your practice’s cash flow so your clinical team can focus entirely on patient care.
Insurance & Payer Services
Simplifying Insurance Processes for Healthcare Providers
StelleMed supports healthcare practices with organized insurance and payer-related workflows, helping teams manage administrative tasks and navigate billing processes more efficiently. By automating upfront eligibility checks, eliminating pre-authorization delays, and resolving complex payer guidelines, we remove administrative friction from your daily operations. Our certified billing team handles claim submissions and aggressive appeals end-to-end, so your providers can eliminate payer headaches and dedicate their full attention to patient care.
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Simplifying Insurance Claims Management
Accurate Eligibility Verification
Precision Medical Coding
Faster Claims & Denial Resolution
Efficient Payment Reconciliation
Services That We Provide
Whether as a full-service partner or to bolster your internal billing team, our certified team handles every phase of the payer lifecycle to ensure maximum legal cash flow.
Eligibility & Benefits Verification
Verify patient active coverage, primary/secondary policy status, co-pays, deductibles, and pre-existing condition rules prior to scheduled visits to prevent claim rejections.
- Real-time automated clearinghouse inquiries (270/271)
- Detailed breakdown of copays, co-insurance, and out-of-pocket maximums
- Elimination of inactive insurance write-offs at the front desk
Prior Authorization
Securing necessary clinical approvals and precertifications from insurance payers before diagnostics, specialty consultations, procedures, and surgeries take place.
- Submission of clinical documentation and medical necessity justifications
- Payer follow-up and turnaround tracking to prevent treatment delays
- Direct tracking of approval numbers matched to billing claims
Provider Credentialing & Payer Enrollment
Comprehensive enrollment and primary source verification with Medicare, Medicaid, and commercial health insurance networks to guarantee billing privileges.
- CAQH profile setup, maintenance, and periodic re-attestation
- Commercial and government payer contract applications
- Continuous tracking of expiring licenses, DEA, and board certifications
Medical Coding
Certified AAPC/AHIMA medical coders assign precise ICD-10-CM, CPT, and HCPCS Level II codes and appropriate modifiers directly from provider documentation.
- Accurate code assignment reflecting clinical diagnosis and care provided
- Correct modifier utilization (e.g. 25, 59, 76) to prevent bundling denials
- Specialty-specific chart reviews and clinical compliance auditing
Charge Entry & Claim Creation
Accurate and rapid entry of patient encounters, fee schedules, diagnostic pairings, and clinical billing charges into the practice management system.
- Verification of dates of service, rendering provider, and facility NPI
- Validation of billed amounts against practice fee schedules
- Same-day encounter charge entry to reduce lag time
Claim Submission
Electronic batch scrub and dispatch of 837P and 837I clearinghouse claim files within 24–48 hours of clinical care.
- Direct clearinghouse transmission across 50+ payer connections
- Electronic validation against 3M+ dynamic payer rule edits
- Same-day resolution of clearinghouse front-end format errors
Payment Posting
Daily posting of Electronic Remittance Advices (ERAs) and manual Explanation of Benefits (EOBs) payments, contractual adjustments, and copays.
- Same-day reconciliation of electronic bank deposits against posted funds
- Line-item posting of allowable amounts, deductibles, and copayments
- Accurate secondary and tertiary payer claim balance rollover
Remittance Reconciliation
Auditing payer remits against contracted fee schedules to catch underpayments, silent contractual recoupments, and incorrect allowable calculations.
- Automated detection of payer payment discrepancies
- Audit of bundled line-item denials and contract violations
- Immediate escalation of incorrect payer fee reductions
Denial Management & Appeals
Aggressive categorization, root-cause investigation, correction, and formal clinical appeal submission for all denied or rejected claims.
- Never writing off legitimate clinical revenue
- Clinical appeal letters with medical record documentation
- Payer denial tracking and prevention of repetitive billing errors
Insurance A/R Follow-Up
Systematic aging accounts receivable tracking at 30, 60, 90, and 120+ days to hold insurance carriers accountable until full reimbursement is recovered.
- Dedicated work-queues prioritizing high-dollar and aged claims
- Direct phone escalations with payer supervisors and claims adjusters
- Resolution of unpaid, stalled, or lost insurance balances
98%
Clean Claim Rate
First-pass acceptance rate
50+
Payer Partners
Direct clearinghouse electronic ties
1,000+
Healthcare Providers
Across 30+ medical specialties
99%
Client Satisfaction
Provider retention & trust
Six Checks Before Every Claim Goes Out
Total accuracy checks and scrubbing before any electronic claim is submitted to avoid rejections and audit penalties down the line.
Demographic Validation
Patient identity, subscriber policy details, active coverage status, and primary/secondary coordination verified.
Policy Active Verification & Prior Auth
Real-time payer eligibility confirmed and pre-authorization numbers validated before service is delivered.
Medical Coding & Modifier Check
AAPC/AHIMA certified coders audit ICD-10, CPT pairing, and modifier logic (25, 59) against payer LCD/NCD rules.
Claim Format & Clearinghouse Scrub
Dynamic clearinghouse validation across 3,000,000+ real-time payer edits before electronic claim transmission.
Fee Schedule & Timely Filing Check
Billed amounts verified against contracted allowable rates and audited against carrier timely filing deadlines.
Payment Reconciled & Stalled Claim Alert
Proactive aging follow-up at 30, 60, and 90 days to eliminate unpaid claim drift and prevent revenue loss.
Why Choose Our Payer and Insurance Services
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Eligibility & Benefits Verification
Real-time 270/271 electronic checks confirm patient coverage, deductibles, copays, and active policy status prior to encounters to prevent upfront rejections.
Prior Authorization & Approvals
Rapid acquisition of insurance pre-certifications and medical necessity approvals before procedures, diagnostics, and specialty treatments take place.
Certified Medical Coding & Audits
AAPC/AHIMA certified coders assign compliant ICD-10, CPT, and HCPCS codes with precise modifiers to eliminate coding-related claim rejections.
Clean Claim Scrubbing & EDI Dispatch
Multi-tier electronic scrubbing against 3M+ dynamic clearinghouse rules ensures 98%+ first-pass clean claim submission within 24–48 hours.
Denial Management & Appeals
Deep root-cause investigation, corrective refiling, and aggressive multi-level clinical appeal letters ensure legitimate revenue is never written off.
Insurance Aging A/R Follow-Up
Relentless accounts receivable tracking at 30, 60, 90, and 120+ days with direct carrier escalations to collect delayed and stalled reimbursements.
Our Mission, Vision and Values
We bridge clinical dedication with financial excellence. Here is why independent physicians, surgical centers, and multi-specialty clinics choose StelleMed as their growth partner.
Our Mission
To simplify the revenue cycle for healthcare providers from claims to payments, eliminating administrative burdens so doctors can focus entirely on patient care.
Our Vision
To be the nation’s leading healthcare financial partner, empowering independent practices and clinical groups with modern technology, predictable cash flow, and financial resilience.
Our Values
Uncompromising integrity, 100% HIPAA compliance, radical billing transparency, and a client-first commitment to protecting every dollar earned by our healthcare providers.
Zero Risk, No Long-Term Contracts
Start with a simple month-to-month agreement. If we don’t elevate your collections, you’re never locked in.
Frequently Asked Questions
Everything you need to know about our billing workflows, HIPAA security, EHR integrations, and pricing model.
We partner with independent physician practices, ambulatory surgery centers (ASCs), urgent care clinics, mental and behavioral health practices, dental and oral surgery clinics, and multi-specialty medical groups across all 50 US states. Our certified billers adapt specifically to each clinical specialty’s coding requirements.
We deploy a rigorous multi-tier prevention protocol: 1) Real-time insurance eligibility checks prior to patient appointments, 2) Specialty-specific automated clearinghouse claim scrubbing rules, 3) Certified AAPC/AHIMA coder charge audits, and 4) Immediate clinical appeals with supporting documentation for any unexpected rejections within 24 to 48 hours.
All client interactions and data exchange operate on StelleCloud™ infrastructure, featuring AES-256 bit encryption at rest and in transit, multi-factor authentication (MFA), role-based access restrictions, and 24/7 security auditing. We execute comprehensive Business Associate Agreements (BAAs) with every provider partner.
Charges received from your clinical practice are reviewed, scrubbed, and electronically submitted within 24 to 48 hours of service. Average reimbursement cycles for clean electronic claims typically range from 12 to 18 days, depending on payer adjudication timelines.
Yes. We offer transparent, percentage-of-collections pricing starting as low as 3.5% to 6%, meaning we only get paid when you get paid. For specialty surgical clinics or administrative credentialing projects, flat monthly retainer packages are also available. We never charge hidden software or setup fees.
No. StelleMed believes our performance should earn your business every month. We operate primarily on flexible month-to-month service agreements with standard 30-day notice terms, so you never feel trapped in a rigid multi-year commitment.
Not at all. StelleMed connects directly with your existing EHR and Practice Management system (such as Athenahealth, Epic, eClinicalWorks, Kareo, AdvancedMD, NextGen, and others). Your clinical staff continues using the software they already know.
- Trusted By Growing Practices
Because Every Practice Deserves Reliable Partners.
StelleMed was built on a simple belief: healthcare providers deserve a billing partner they can trust — transparent, accountable, and focused on results.