Medical Billing Companies & Consultants in Cranberry Twp, PA

Medwave Billing & Credentialing is a revenue cycle firm based in Cranberry Township, Pennsylvania, a short drive north of Pittsburgh. It works with healthcare organizations across the country, from solo physicians and group practices to allied health clinicians and multi-specialty organizations. Its focus is the administrative side of a practice: enrolling providers with payers, getting fair contract terms and turning patient visits into collected revenue. The company says it has worked with more than 15,000 providers, reports a clean claim rate of 98% and takes about 85 days on average to complete credentialing.

Medical Billing Services

Medwave's billing staff cover the full life of a claim. That includes recording charges, checking codes, sending claims, posting payments and working denials. Before a claim goes out, staff confirm that the procedure codes match the diagnosis codes and that the insurance and patient details are complete. The goal is fewer rejections and less follow-up work. The firm says it keeps its billing work in-house rather than sending it offshore, and that experienced staff handle each account and challenge denials they believe are wrong. For older unpaid balances, its A/R recovery service reviews and reprocesses aged claims. Its denial management work looks for the root causes of denials and files appeals.

Technology and Automation

The company uses HL7 standards to move data both ways between billing platforms and a practice's EHR. It also uses robotic process automation for repetitive, high-volume tasks such as eligibility checks, claim submission and payment posting. Medwave suggests automation for clients whose claim volume justifies it, as a way to lower costs, reduce manual keying errors and give practices a live view of how their revenue cycle is performing.

Credentialing and Contracting

Medwave pairs billing with credentialing and payer contracting, which it sees as closely tied to how much a practice collects. Its credentialing staff register providers with commercial insurers as well as Medicare and Medicaid. They also set up and maintain CAQH profiles, resolve application gaps and track recredentialing and revalidation dates so providers are not left unable to bill. For contracting, Medwave reviews a practice's current agreements and compares its fee schedules with Medicare rates and with what peers in the market are paid. It then flags underpaid CPT codes and negotiates with payers using the client's own claims data. It also checks contract terms such as termination clauses, timely filing rules and audit rights.

Specialties Served

Medwave lists dozens of specialties it supports, including:

• Behavioral health, psychiatry and substance abuse treatment
• Primary care, pediatrics and internal medicine
• Cardiology, dermatology, gastroenterology and oncology
• Lab services such as genetic testing, toxicology and pharmacogenetics
• Physical, occupational and speech therapy
• Remote patient monitoring, telestroke and digital therapeutics
• Home health, DME and skilled nursing facilities

The firm also offers telehealth billing and revenue cycle consulting. Clients can hire it for a single service or for full revenue cycle management. Its materials say it has been in operation since 2000 and describe its credentialing experience as spanning more than three decades.