Reimbursement & Resolution
Claims & A/R Administration
Ellery manages payer-facing claim and accounts-receivable workflows that require status follow-up, investigation, documentation, and resolution.
Overview
Once a claim has been submitted, getting it adjudicated correctly is payer-facing work: finding out where it stands, supplying what the payer says is missing, resolving administrative holds and coordination-of-benefits questions, pursuing claims that have stalled, and identifying claims that paid at zero or below the contracted amount. That work competes for the attention of billing staff who also have charge entry, coding, and patient balances to manage.
Ellery Health Partners takes ownership of the payer-facing side. We research claim status through payer portals and telephone follow-up, work pending, stalled, and aging claims, resolve missing-information requests and coordinate medical-record requests, manage payer correspondence and escalation, and follow reprocessing requests and payer commitments through to the payer’s final determination. Zero-pay claims, underpayments, and contract or payment variances are identified and pursued with the payer through its reprocessing and dispute processes; recoupments and takebacks are researched and responses coordinated. Whether a variance is recovered is decided by the payer. Corrected claims and resubmissions are coordinated when the practice or its billing system supplies the corrected billing information. Aging and payer trend reporting shows where the receivable is concentrated and why.
What Ellery Health Partners handles
Claim status and follow-up
- Claim-status research through payer portals and payer telephone follow-up
- Pending, stalled, and unprocessed claim follow-up
- Aging accounts-receivable follow-up
- Missing-information resolution and medical-record request coordination
- Payer correspondence and payer escalation
- Administrative hold and coordination-of-benefits follow-up
- Reprocessing-request follow-up
- Tracking payer commitments through the payer’s final determination
Payment variance and recovery support
- Zero-pay claim investigation
- Underpayment and contract or payment variance identification
- Underpayment recovery follow-up with the payer
- Recoupment and takeback research and response coordination
- Corrected-claim and resubmission coordination when corrected billing information is supplied
- Aging reporting and payer trend reporting
Where it sits in payer operations
Claims and A/R work relies on the eligibility, referral, and authorization record established ahead of the visit, and hands off to denials and appeals when a payer’s adverse decision requires a formal response. For billing companies, it is the payer-facing layer that complements charge entry, coding, and patient billing.
Within your existing systems
Ellery Health Partners performs this work inside the systems your practice authorizes for the assigned workflow: the EHR or practice-management system, payer portals, pharmacy benefit manager and specialty-pharmacy platforms, clearinghouses, CAQH and PECOS, and the payer telephone channels the work requires.
Your practice provisions the accounts, sets the permissions, and can modify or revoke access at any time. Nothing is moved into a separate Ellery Health Partners patient database.
Reporting and accountability
Ellery documents payer activity within the practice-approved systems used for the engagement, with supplemental operational tracking where appropriate. That tracking is aggregate and contains no protected health information; patient-level case detail stays in your systems.
Reporting appropriate to the engagement covers case status, last payer action, next follow-up, deadlines, determinations, unresolved issues and escalations, and the administrative barriers that recur.
Service boundaries
Ellery owns the payer-facing claim and accounts-receivable workflows defined in the engagement.
Responsibilities retained by the practice or billing organization
- Medical coding and coding review
- Charge entry and routine claim creation
- Patient collections and patient statement processing
- Patient balance inquiries
- Management of the broader billing system and patient financial relationship
Ellery operates alongside the practice’s existing billing infrastructure as the accountable administrative layer for the payer-facing workflows assigned to us.
When work is scoped separately
Routine claim follow-up is included in targeted Claims & A/R Administration engagements and Payer Desk engagements. Scoped separately as projects:
- Underpayment recovery follow-up across a defined date range or payer
- Recoupment and takeback response projects
- Aged accounts-receivable clean-up of a legacy receivable
- Payer-specific escalation programs
- Volume above the capacity documented in the written scope
Specialties where this work is concentrated
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.