Services
Managed payer administration for independent medical practices.
Ellery Health Partners provides defined payer-administration services across prior authorization, insurance verification and benefits, claims follow-up, denial and appeal support, and provider credentialing and payer enrollment. Services may be engaged individually or combined within a defined monthly scope.
Insurance Verification & Benefits
Coverage and benefit verification through approved payer channels.
Ellery Health Partners verifies patient coverage and relevant benefits using payer portals and direct payer contact when additional clarification is needed.
Available individually through the Verification & Benefits Desk or as part of a Payer Desk plan.
Includes:
- Active coverage verification
- Effective-date confirmation
- Plan information
- Applicable benefit information
- Deductible and coinsurance information when available
- Copay information when available
- Authorization requirement checks
- Referral requirement checks
- Payer phone verification when needed
- Documentation of verification results
Verification reflects information provided by the payer and does not guarantee payment.
Claims Follow-Up
Claim status research, payer follow-up, and documented next actions.
Ellery Health Partners follows up on submitted claims that require payer-side administrative attention. We identify the current status, document the reason for delay or nonpayment when available, and identify the next administrative action required.
Available individually through the Claims Follow-Up Desk or as part of a Payer Desk plan.
Includes:
- Claim status checks
- Payer portal research
- Payer phone calls
- Processing-status follow-up
- Administrative hold identification
- Missing-information identification
- Follow-up on payer requests
- Reference and call-number documentation
- Escalation when appropriate
- Status reporting back to the practice
Claims Follow-Up does not include medical coding, charge entry, or full-service medical billing unless expressly added to a future Ellery Health Partners service.
Denial & Appeal Support
Administrative support for denial review, submission, tracking, and payer follow-up.
Ellery Health Partners handles the administrative work required after an authorization or claim denial. We review the payer’s stated reason, gather the required administrative documentation, coordinate with the practice when clinical input is needed, submit the appropriate materials, and follow the case through the payer’s process.
Formal appeal services are priced separately from standard monthly case allowances.
Includes:
- Denial reason review
- Payer follow-up
- Required-document identification
- Documentation coordination
- Appeal submission support
- Reconsideration support
- Status tracking
- Payer calls
- Administrative escalation
- Final status documentation
Clinical appeal content requiring medical judgment remains the responsibility of the treating provider or appropriate clinical staff.
Provider Credentialing & Payer Enrollment
Credentialing and enrollment administration from application through payer determination.
Ellery Health Partners manages the administrative workflow involved in provider credentialing and payer enrollment, from application preparation through payer follow-up and status tracking.
Credentialing and enrollment are priced separately by provider, payer, or defined enrollment package.
Includes:
- CAQH administrative support
- Provider information collection
- Application preparation
- Commercial payer enrollment
- Medicare and Medicaid enrollment support where within scope
- Application submission
- Missing-information follow-up
- Payer correspondence
- Status checks
- Revalidation tracking
- Roster and demographic update support
- Final status documentation
Enrollment and credentialing decisions are made by the applicable payer or organization and cannot be guaranteed by Ellery Health Partners.
Services outside our current scope
Ellery Health Partners does not currently handle pharmacy-benefit prior authorizations for medications filled through retail, specialty, or mail-order pharmacies.
Ellery Health Partners also does not perform:
- Clinical decision-making
- Medical-necessity determinations
- Medical advice
- Diagnosis or procedure code selection
- Code changes or coding recommendations
- Treatment recommendations
- Peer-to-peer clinical reviews
- Provider signatures or attestations
- Representation as the treating provider
- Clinical answers to payer questions
- Work outside the written service scope without practice approval
Where a case requires clinical input, Ellery Health Partners returns the question or request to the appropriate practice representative.
How every engagement is structured
Written scope and pricing
The included services, responsibilities, case capacity, exclusions, and pricing are documented before service begins.
U.S.-based administrative support
Contracted payer-administration work is performed by personnel located in the United States through practice-approved systems and payer workflows.
Practice-controlled access
The practice provisions, controls, and can revoke the system accounts and permissions used by Ellery Health Partners.
Work inside authorized systems
Payer-administration activity is documented in the practice’s authorized workflow.
Business Associate Agreement
The Business Associate Agreement and applicable security, training, device, and access requirements are completed before Ellery Health Partners begins live work involving protected health information.
Approved additional work
Services outside the agreed scope require practice approval before they are performed.
Begin with a clear scope
Tell us which payer-administration workflows you want help with, your approximate monthly volume, and the size of your practice. We will review the scope and determine whether Ellery Health Partners is a fit.
No patient information is requested or accepted through this website.
Ellery Health Partners does not guarantee payer approval or payer response time.
Business Associate Agreement before access
Practice-controlled system access
U.S.-based personnel
Documented in your authorized system