Medical Billing Companies & Consultants in Philadelphia, PA

Mediclaim, Inc. is an outsourced medical billing firm in Philadelphia. It has handled claims for physician practices since 1990. Over more than thirty years, the company says it has recovered more than $485 million for its clients. It works from one office in Philadelphia. Its published service areas cover southeastern Pennsylvania (Bucks, Chester, Delaware and Montgomery counties, plus Reading), Delaware (Wilmington and Newark) and New Jersey, including Princeton, Toms River and South Jersey.

The firm works mainly with independent practices and says it has billed for almost every medical specialty. Specialties it names include:

• Primary care
• Podiatry
• Allergy
• Neurology
• Gastroenterology
• Pediatrics
• Pain management
• Dermatology

Scope of Services

Mediclaim covers the whole revenue cycle. It enters charges and patient demographics, posts payments from explanation-of-benefits forms, fixes and resubmits denied claims, and bills secondary and tertiary insurers. It also sends patient statements and follows up on claims that payers have not answered. Patients with questions about a balance call Mediclaim, and its staff help them understand what they owe or sort out insurance problems. The company says clearly that it is not a collection agency and that it treats patients with courtesy. Practices can log into an online portal to see demographics, claim history, patient balances, reimbursement by CPT code and payer mix.

How Engagements Work

To start, a practice sends its details and signs the EDI enrollment forms. Setup takes about five business days. After that, the practice sends encounter forms, either its own superbill or one Mediclaim designs for it. Forms can go by fax, email, mail or FedEx, and Mediclaim supplies the shipping materials. Offices near Philadelphia can have a courier pick up paperwork every week. Most charges are keyed in within a day and sent to payers electronically that night. Rejections show up on payer reports and are fixed right away. The firm says it returns fewer than half a percent of forms to offices for missing information.

Mediclaim never handles client money. Insurance payments go straight to the practice, though the firm can help set up electronic deposits into the practice's own bank account. Offices send their EOBs along with new charges so staff can post payments and work denials. Claims with no response after 45 days are investigated. Any remaining balance moves to another insurer or to the patient. Patient statements go out weekly on a six-week cycle. They show the practice's name but Mediclaim's phone number.

What Distinguishes the Firm

Mediclaim says it processes claims within 48 hours and has a pass-through rate of 98 percent. It puts its accuracy down to careful coding and keeping up with changing billing rules from commercial insurers and government programs. The firm charges a monthly percentage of what the practice actually collects. It does not take a fee on capitation payments, adds no extra charges and does not require a long-term contract. If a practice decides to leave, Mediclaim offers to help with the move. The company considers its client service the main thing that sets it apart.

Nextus Billing Solutions is a revenue cycle management firm that focuses entirely on behavioral health. Its clients are mostly addiction treatment centers, detox facilities and mental health programs, organizations whose staff often struggle to balance clinical work with insurance demands. Operating from offices in Philadelphia and Boca Raton, the company takes on the payer side of the business so that facility owners and their teams can devote more attention to the people in their care.

Services

Nextus provides an end-to-end package that follows a patient's financial journey from admission through final payment. Its core offerings include:

• Benefits verification before admission, with Nextus staff handling the lengthy calls to insurers, aimed at greater accuracy, quicker reimbursement and fewer denials
• Utilization review covering authorizations, records management and efforts to secure lengths of stay that fit each patient's clinical needs
• Claim preparation, submission and ongoing follow-up
• Negotiation of out-of-network and other third-party payments to increase reimbursement
• Provider credentialing along with payer contract and network management
• Clinical documentation support, including training sessions for clinicians
• A dedicated account manager assigned to every client

The firm notes that insurers frequently search for grounds to reject claims, and it relies on its specialized knowledge of behavioral health billing to work through those obstacles.

Technology

A key differentiator is Cereus, a software platform Nextus developed in-house. Through it, clients can monitor their revenue cycle and follow claim activity in real time. The company says Cereus draws on years of accumulated claims history to project likely insurance payments, giving facilities a firmer basis for financial planning and operational decisions. Nextus also emphasizes a thorough internal checking process before anything goes out to payers, which it credits for a first-pass acceptance rate of 99 percent.

Working style

Nextus organizes its approach around four ideas: consulting, collaborating, persevering and executing. It aims to treat each client's operation with the same care it would give its own, to communicate promptly and to keep pursuing unpaid claims until money arrives. The company describes its service as concierge-level, built on innovation, transparency and responsiveness. Testimonials from treatment providers in Florida, New Jersey, Ohio, Tennessee and California point to clear communication, strong visibility into billing activity and the value of having one designated contact. Several clients mention earlier frustrations with other billing vendors and describe the move to Nextus as smooth. Prospective clients typically begin with a consultation that examines the facility's existing billing practices.

Leadership and mission

The company is led by Chief Executive Officer Vinny Resnick and Chief Operating Officer Yves Sidney, supported by vice presidents overseeing operations, human resources and organizational development. Its mission rests on the conviction that every claim represents a real person looking for help, whether a relative, friend or neighbor, and Nextus says this belief motivates its persistence on behalf of providers. Internally, the firm promotes a supportive culture and competitive pay for its staff. Facilities seeking a billing partner devoted specifically to substance use and mental health treatment, with proprietary reporting tools and a hands-on account management model, may find Nextus well suited to their needs.

Overview

Therapeutic Billing Co. also does business as FastTrack Credentialing. It is a revenue-cycle and credentialing firm that works only with behavioral health practices. Its clients include therapists, psychologists, psychiatrists, psychiatric mental health nurse practitioners (PMHNPs) and group practices, from solo clinicians to organizations with several sites. The company behind the brand is Therapeutic Billing For Mental Health Providers LLC, and the firm says it can take on clients in every U.S. state.

Billing and Revenue-Cycle Services

The firm covers the whole claims process for counseling and psychiatric practices. That starts with checking a patient's coverage before a session and ends with collecting the balance afterward. Its billing work includes:

• Preparing electronic claims and sending them to commercial insurers, Medicare and Medicaid
• Posting insurer and patient payments, including electronic remittance (ERA) and funds transfer (EFT) records
• Looking into rejected claims, fixing coding or data errors, and filing appeals
• Following up on unpaid insurance and patient balances to shorten aging receivables
• Patient statements, installment plans and answering account questions
• Checking eligibility and behavioral health benefits ahead of visits
• Revenue reporting for the practice

Billing is charged at a flat weekly rate instead of a percentage of collections. The company says new clients pay no sign-up fee and can start right away without a waiting period. Buyers should know that, under its stated policy, it does not give refunds and has not accepted payment by check since mid-2020.

Credentialing and Practice Setup

Besides billing, the firm handles insurance credentialing under its FastTrack name and says it starts applications on the same day a provider signs up. For clinicians opening a new practice, it also helps with forming the business and setting up an LLC, creating an organizational NPI, and notary services. It also sells an online medical billing course for providers or office staff who want to learn to manage claims themselves.

Background and Team

Sadaqah Farrar founded the business in 2011 and is still its chief executive, with more than 16 years of experience in behavioral health credentialing and billing. Each client gets a dedicated account manager, and the staff are billing specialists who focus on mental health. The company stresses that all of its representatives work in the United States and hold HIPAA certification, and that it never sends work to overseas contractors.

The firm lists eleven offices: Jersey City, New Jersey; New York City; Philadelphia; Morrisville, North Carolina; North Myrtle Beach, South Carolina; Port Saint Lucie, Florida; Hollywood, California; Solon, Ohio; Spanish Fork, Utah; Chicago; and Honolulu. Support is available seven days a week, with long evening hours on weekdays. Practices thinking about switching vendors can book a free consultation to go over their claims, denial and credentialing needs before signing on.