Ambulatory surgery centers
Payer administration for ambulatory surgery centers
Procedure authorization, facility benefits and financial clearance, referrals, claims and accounts-receivable follow-up, denials and appeals, and facility credentialing, enrollment, and network participation, handled within your systems by Ellery’s U.S.-based team.
What lands on our desk
- Procedure authorization for scheduled cases, including confirmation that the authorization names the facility as the site of service and covers the date and the procedure codes on the schedule
- Facility benefits verification, patient-responsibility estimates, and financial clearance ahead of the date of service
- Referral requirement checks for plans that require them
- Facility claim follow-up, underpayment and contract-variance identification, and recoupment response
- Denial and appeal administration for authorization, coverage, site-of-service, and administrative denials
- Facility and provider credentialing, payer enrollment, revalidation, and roster maintenance as surgeons are added
- Payer participation requests, contract administration, and fee-schedule review for the facility
Administrative demands in a surgery center
A surgery center’s payer work is organized around the schedule. Every case needs a valid authorization that names the facility as the site of service, a benefit check that reflects facility rather than office benefits, and a financial-clearance status before the patient arrives. After the case, the facility claim is measured against a fee schedule that is often negotiated separately from the surgeons’ own contracts, and underpayments and site-of-service denials need dedicated follow-up. Facility enrollment and network participation, including adding new surgeons and new payers, keep the center able to schedule cases at all.
How a case runs here
Ellery Health Partners locates and organizes the documentation the payer’s published criteria require, flags anything missing to your coordinator, submits through the channel your practice approves, monitors status, completes routine payer follow-up, coordinates routine additional-information requests from the record, and records every action, reference number, and outcome in your system. If a request is denied, Ellery Health Partners records the payer’s stated reason, the deadline, and the directed next step, and administers the appeal where that is in scope.
What stays with your practice
Clinical decisions, medical necessity, prescribing decisions, diagnosis and procedure code selection, physician peer-to-peer reviews, provider signatures and attestations, and clinical answers to payer questions remain with the treating surgeons and the center’s clinical staff. When a payer asks a clinical question, Ellery Health Partners documents it and routes it to the contact you designate.
Get started with Ellery Health Partners
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.