Medical Billing Companies & Consultants in Cleveland, OH

Great Lakes Billing Associates, Inc. operates from the greater Cleveland area and works exclusively on reimbursement for ambulance and emergency medical transport services. Hospital and physician billing fall outside its scope. Its client base spans government-operated EMS providers in Ohio and Indiana, including those run by counties, municipalities, villages and townships, along with independently owned ambulance operators.

Because the company focuses on a single niche, agencies looking for a collections partner fluent in transport reimbursement will find that its people, processes and tools all center on that work. In the company's own view, its role is to bring in the revenue that lets emergency services keep their fleets, clinical equipment and technology current.

Discovery and Account Setup

Every engagement starts with a review phase. The firm's analysts look at an agency's yearly call volume and the proportion of advanced life support to basic life support runs, then project likely Medicare revenue based on the program's Ambulance Fee Schedule. Jurisdictions weighing whether to bill only the insurance carriers of local residents can work through what OIG Advisory Opinion 01-10 means for that approach. Help during the startup period can cover:

• Reviewing unpaid accounts, judging whether past Medicare and Medicaid denials can still be pursued, and offering guidance on turning balances over to a third-party collection agency
• Walking agency staff through provider registration with Medicare, Medicaid, Railroad Medicare, Champus/Champva, Federal Black Lung, the Bureau of Workers Compensation, Anthem BCBS and other carriers
• Setting up a lockbox so carrier remittances flow straight into the agency's own bank account rather than arriving as one check each month
• Recommending rate structures designed to improve revenue
• Reviewing patient care report formats and sample charts to confirm they satisfy Medicare documentation requirements

Day-to-Day Revenue Cycle Work

Once an account is active, the firm handles the full billing cycle. Its team verifies insurance eligibility ahead of filing, reviews each trip for medical necessity, applies ICD-10 diagnosis codes, enters charges with the procedure codes particular carriers expect, files claims electronically, and posts payments and adjustments promptly so secondary billing can move forward without delay.

Denials are contested at every level of Medicare's appeals ladder, up to and including hearings before an Administrative Law Judge where appropriate. For patients without coverage, the client agency sets the policy: statement frequency, message content, the number of follow-up notices, and when an unpaid balance is either written off or sent to collections.

Run data can be pulled in electronically from a range of charting systems, among them ESO, IMS, EnCharge, HealthEMS, EMSCharts, Emergency Reporting and Zoll's RescueNet. Other programs can be integrated following a case-by-case evaluation.

Reporting and Supplemental Offerings

The firm's system can sort results by virtually any data element captured, and its staff build custom reports to assist with local government budgeting and analysis of transport patterns.

Optional services include a toll-free number for patient questions, information feeding an agency's quality assurance efforts, patient satisfaction surveys, community events where residents get help sorting out insurance matters (including ones that have nothing to do with ambulance care), training for EMS crews on charting and billing practices, orientation resources for new hires, and coordination with hospitals to streamline access to patient information.

To keep pace with regulatory change, all staff complete yearly Medicare and Medicaid training, and managers take part in national industry conferences as well as meetings of Ohio's statewide ambulance trade organization. Pay for employees is linked to the outcomes they deliver for clients. EMS agencies comparing billing vendors will likely see the strongest advantages in the company's sole focus on ambulance reimbursement, the long tenure of its billing team, and the consultative way it brings new clients aboard.

Quadax, Inc. is a healthcare revenue cycle company that pairs its own claims software with hands-on billing support. Its offering covers the whole path of a claim, starting with checks done before the patient is seen and ending with payment posting and analysis. The company traces its history in healthcare reimbursement back more than five decades. It markets itself as an independent partner and not simply a technology vendor.

Who Quadax Serves

The company groups its clients into three main markets, and each one gets its own set of solutions:

• Hospitals and health systems that handle large claim volumes across several service lines and EHR platforms
• Ambulatory, physician and specialty providers, including home health, skilled nursing, hospice, post-acute and long-term care organizations, plus independent medical billing firms
• Laboratories and pathology groups, along with DME/HME suppliers that need high-throughput A/R management

Products and Services

The core product is Xpeditor, the company's own clearinghouse and claims management tool. It checks claims in real time, applies edits specific to each payer and routes claims automatically, so many errors are caught and fixed before submission.

Hospital clients can write as many custom rules as they need without paying extra, and they also get autocorrect, conversion, edit and suppression functions. Xpeditor runs on QDXOne, a unified platform that connects patient access, claims and reimbursement work in one place.

The analytics layer, iQ: Intelligence by Quadax, uses AI and historical claim patterns to point out denial trends and payer behavior. A second product, SafetyNet, acts as a backup clearinghouse. Organizations can use it to keep claims flowing during outages or to handle particular business lines.

Other modules include eligibility verification and coverage discovery, patient cost estimates, ERA-based remittance retrieval and posting, checks of payments against contracted rates to find underpayments, and organized workflows for denials and appeals.

Flexible Engagement Models

Laboratories have three ways to work with Quadax. They can license the platform and run billing with their own staff (SaaS). They can hand billing over to Quadax specialists, who take on payer follow-up, A/R and pathology billing (BPO). Or they can use a hybrid model that keeps oversight in-house while adding outside capacity.

Quadax reports more than 30 years of laboratory billing experience and more than 5,000 active payer relationships. It also says over a third of its staff have at least ten years in billing. Lab services also cover invoicing, patient statements, print-and-mail and IVR-based patient billing support.

Background and Differentiators

Quadax is based in Middleburg Heights, Ohio, a suburb of Cleveland. It reports a 99.7 percent first-pass clean claim rate and a 98 percent client retention rating. It also says KLAS Research has recognized it five times for clearinghouse and claims management. Support is handled entirely in-house.

Clients get dedicated account managers and tiered specialists who stay with an issue until it is resolved. The company also works with technology firms that want to integrate, cobrand or white-label its clearinghouse capabilities. That can matter to software vendors and billing companies as well as to providers.

RelateCare is a healthcare services firm that works with hospitals, health systems, academic medical centers and children's hospitals. Its focus is the patient access side of the revenue cycle: scheduling, the first contact a patient makes, and the administrative steps that come before a visit. Huron, the professional services firm, has since acquired the company.

RelateCare does not offer full back-end billing, such as claims submission and denial follow-up. Buyers comparing medical billing vendors should therefore see it as a front-end revenue cycle and access partner.

Revenue Cycle and Patient Access Work

RelateCare staffs patient contact centers around the clock, every day of the year. These centers act as an outsourced arm of a provider's own access department. The company's consultants look at the revenue cycle workflows that happen before a claim exists.

They find bottlenecks and timing problems that cause revenue to be lost or delayed, then help put better processes in place. Their methods include lean process redesign, workforce management tools and automation where it makes sense. The goal is to capture more revenue and open new collection opportunities for health systems.

In RelateCare's view of a well-run patient visit, insurance has been pre-authorized and the needed tests are done before the patient arrives.

• 24/7 patient access and scheduling contact centers
• Revenue cycle optimization for front-end workflows
• Access and scheduling optimization, including template and protocol review
• Planning a future-state, multi-channel access center
• Workforce management, forecasting and staff capacity planning
• Decision-tree tools to guide patient scheduling

Clinical Support Services

RelateCare also runs a clinical team of registered nurses, medical assistants and health coaches. This team offers 24/7 nurse triage using Schmitt-Thompson protocols, and it handles in-basket clinical messaging and prescription refills under each client's own policies. Other programs cover care coordination, chronic condition management, calls before surgery and follow-up after discharge.

The company also offers prevention and wellness campaigns, virtual ambulatory care nursing, clinical program design and a hospital transfer center. RN-led staff record their work directly in the client's electronic health record.

How It Works With Clients

RelateCare usually starts by reviewing a client's current operations. It then makes recommendations, lays out a roadmap for delivery, and supports the client through implementation. Its contact center and clinical teams work as part of the provider's own staff rather than as a separate service. Client references include Stanford Medicine Children's Health, which has worked with RelateCare since 2013, along with VNA Health Group and an innovation leader at Cleveland Clinic.

Background and Credentials

RelateCare was founded in 2013. It has US operations based in Cleveland, Ohio, and also recruits staff in Ireland. The company says its data protection and compliance practices follow HIPAA and ISO/IEC 27001. Its strengths are clinical depth paired with access-center know-how. That fits organizations whose revenue problems start at scheduling, registration and authorization, rather than at coding or claims.

Headquartered in Cleveland, Ohio, ResolvaBill Medical Billing Services, LLC specializes in revenue cycle management for medical providers ranging from solo and small group physician practices to sizable healthcare organizations. By outsourcing their claims and reimbursement tasks to ResolvaBill, practices free up their doctors, nurses and front-desk teams to focus on patient care.

The company describes its purpose as offering reliable and open billing assistance. It works to strengthen a practice's income through accurate code assignment, prompt claim submission and persistent pursuit of outstanding balances.

What the Company Offers

ResolvaBill handles every stage of reimbursement, starting when a charge is created and ending when the payer remits or an appeal is resolved. Its core offerings include:

• Claims preparation and coding: staff key in charges, scrub them for mistakes and transmit them electronically using CMS-1500 or UB-04 forms to whichever payer is first, second or third in line, with the company targeting a two-day turnaround.
• Coverage verification and pre-approval: on a daily basis, the team confirms each patient's insurance, whether the provider participates in the plan and what the patient will owe, and it obtains required authorizations ahead of treatment.
• Remittance entry and denial resolution: incoming insurer payments, deductibles and adjustments are logged promptly, and statements are generated for patients. Claims that come back rejected or denied receive immediate attention, and the firm submits appeals when warranted.
• Receivables oversight: each week the team examines aging reports, giving priority to anything unpaid beyond 45 days. Outstanding balances are reconciled and potentially uncollectible accounts are evaluated.
• Data and performance reports: providers receive monthly, quarterly and annual summaries that help them monitor revenue and practice results.
• Payer enrollment and agreements: ResolvaBill submits applications to join insurance panels and negotiates contracts, allowing providers to bill at in-network status.
• Advisory and staff education: an independent assessment of a practice's operations that identifies patterns, recommends workflow improvements and prepares office personnel.

Client Engagement

ResolvaBill partners with each practice to understand what it wants to achieve, then designs a customized billing arrangement around those objectives. Instead of billing per claim, it charges one fixed monthly rate that includes all submissions, and it promotes adaptable pricing plans. Practices considering the service may schedule a no-cost initial meeting.

Beyond billing, the company offers guidance on running a physician practice. According to ResolvaBill, its RCM Continuum model can cut staffing and overhead expenses, decrease claim denials, strengthen revenue flow, aid in meeting regulatory requirements and improve patient retention.

Leadership and Qualifications

Jamilya 'J' Ashley-Newell founded the company and serves as its chief executive. Her career in healthcare spans over a quarter century and includes clinical work, administrative roles and consulting engagements in which she directed staff and guided organizations through operational transitions.

Academically, she earned a B.S. degree focused on health administration, along with an associate degree in applied business with a concentration in business management. She is credentialed as an Allied Health Instructor, Certified Billing and Coding Specialist, Certified Clinical Medical Assistant, Certified Medical Administrative Assistant and Certified Professional Biller.

Her professional affiliations include American Medical Technologists, AAPC and the National Healthcareer Association. ResolvaBill reports that every person on its staff likewise brings over 25 years of industry experience.

Practices weighing billing partners may note several distinguishing features: a predictable fixed monthly fee, a chief executive with multiple professional certifications, and a staffed office in Cleveland that is open to client visits on weekdays during regular hours. The company states that it monitors evolving coding rules and compliance standards to help prevent denials. While rooted in Northeast Ohio, ResolvaBill intends to serve medical practices nationwide.