Patient Demographics and Charge Entry:

1. Pre-Sales Requirements Analysis:

This process commences once Episource receives Client approval to conduct process study and to submit a presentation on the benefits of business process management through outsourcing. During this process Episource will conduct the Client Requirements Analysis Study. The study will involve specialties covered, turn around time required, type of files, reports requirement, and formats to be followed.

2. Receipt of Files from client:

Episource receives scanned copies in “.tif” format of patient registration sheet, superbill, and insurance card copies from the client through a FTP site.

3. Download and Allocation of Files:

The files uploaded from the client using the FTP site will be downloaded by Episource’s Medical Billing Team and allocated to the appropriate Demographics and Charge Entry Team.

4. Patient Demographics Entry:

After the files are downloaded and allocated to the appropriate team, the Demographics team enters details such as patient first and last name, social security number, insurance and guarantor details.

5. Charge Entry:

After the files are downloaded and allocated to the appropriate team, the Charge Entry team inputs all charges associated with the procedures that are coded into the billing system.

6. Claims Submission:

On successful completion of the Charges Entry, a claim is submitted electronically from the client billing system to the insurance company. For paper claims, HCFA 1500 or UB 92 forms are files, scanned, and uploaded to the Episource FTP site that is forwarded to the client to be mailed.

7. Client Feedback:

On receiving Quality Feedback from the Client, Episource shall work towards improvement and refinement in the Billing Process in order to provide the most accurate and reliable services.


Payment Posting:

1. Receipt of Files from client:

Episource receives scanned copies in “.tif” format of EOBs (Explanation of Benefits) and checks from the client through a FTP site.

2. Download and Allocation of Files:

The files uploaded from the client using the FTP site will be downloaded by Episource’s Medical Billing Team and allocated to the appropriate Payment Posting Team.

3. Patient Demographics Entry:

After the files are downloaded and allocated to the appropriate team, the Payment Posting team enters details such as patient account number, billed amount, allowed amount, adjusted amount, paid amount, and denial details into the billing system.

4. EOB Follow-Up:

For partial payments, analysis is done and corrective action is taken.

5. Denial Analysis:

Episource billing resources, with substantial experience in the U.S healthcare industry, analyze the EOBs and the claims and take the necessary actions to recover the due amount.

6. Client Feedback:

On receiving Quality Feedback from the Client, Episource shall work towards improvement and refinement in the Billing Process in order to provide the most accurate and reliable services.