SJ Health Insurance Advocates employs a team of data analysts and developers to deliver the key performance indicators you need to seeing the success of your business in an easy-to-navigate platform. Seeing which levels of care you are providing the most of and which carriers reimburse the most per diem and for how many authorized days enables you to make informed admissions decisions.

• Monthly charges and trends in aggregate and by the level of care and insurance carrier.
• Monthly reimbursements and trends in aggregate and by the level of care and insurance carrier.
• Waterfall Report details charged amounts, reimbursed amounts, payment amounts, and how long it takes for claims to adjudicate from the date of submission. Further, dive in to see which levels of care and which carrier pay faster than others.
• UR Analysis details authorizations by the level of care and carrier.

As SJ Analytics is developed in-house, clients can request SJ to build custom reports to meet clients’ specific needs.

SJ Health Insurance Advocates works with treatment centers and clients to verify and understand their benefits as it relates to the specific treatment service being provided. We have a dedicated team of professionals who will verify benefits by completing a thorough inquiry with the insurance company and detailing this information in an individualized template. SJHIA will also work with clients by understanding their benefits, their expected reimbursement, and the specifications of their policy. SJHIA’s thorough and timely approach to verifying benefits often results in increased admissions and higher client satisfaction.

Clients may hire SJHIA to complete appeals on their behalf. This may occur if treatment was never authorized, or if treatment was denied somewhere in the authorization process. SJHIA will comprehensively evaluate your case, including but not limited to reviewing your medical records, in order to determine which appeal options may be the best fit. SJHIA employs fully licensed therapists with extensive experience navigating the appeals process in order to advocate on behalf of the client.

SJHIA continues to seek authorization and reimbursement through the duration of treatment. This includes concurrent reviews with the insurance company to continue to prove medical necessity for the level of care being rendered. These reviews are also completed by fully licensed therapists who utilize their strong clinical background to advocate for the client’s treatment.

SJHIA works to diligently generate and submit claims, as well as track them throughout the entire process. SJHIA identifies issues immediately and works to resolve them in a timely fashion in order to have claims processed and paid as quickly as possible. Unique to SJHIA, we utilize software that allows for complete transparency and accountability into this process. Our billing software allows treatment providers to see exactly where and how claims are being processed and the work being done to have these claims paid. There is a dedicated team that works specifically with you; understanding the nuances of your claims, customizing reports designed specifically for you, and succeeding in maximizing your revenue.

Entering treatment can often be a difficult and overwhelming experience. SJHIA works with your treatment providers to reduce any additional stress that may come from seeking authorizations and reimbursement. SJHIA completes initial authorization requests with insurance companies in a thorough and timely manner in order to set clients up for reimbursement success. Competent, fully licensed staff complete the initial authorization request to prove medical necessity for the specific treatment being rendered. SJHIA maintains consistent and timely communication with both clients and treatment providers. SJHIA differentiates itself by taking the reins in this process and allowing for the client and/or treatment provider to determine their level of involvement.

We DON’T stop at the low-hanging fruit….

We often hear when speaking with prospective clients that most other revenue cycle management companies accept whatever payment an insurance carrier will pay and then close the claim. SJ Health Insurance Advocates has a dedicated team of quality assurance representatives that take the claim adjudication process many steps further.

After all claims are adjudicated, SJ has thirteen additional steps taken to ensure all claims adjudicated in line with the maximum reimbursement allowed per your patient’s policy. SJ has built a sophisticated reporting suite designed to scrub each claim looking for anomalies in reimbursement. When such anomalies are found, the QA Team gets an alert to review the specific claim in greater detail. This due diligence lends itself to higher reimbursement for services.

SJ Health Insurance Advocates provides all the tools you and your patients need to manage the patient payment cycle so you can:

• Speed up the patient collection process.
• Improve the patient experience.
• Gain accurate visibility into receivables.
• Enhance your bottom line.

Clients leave hundreds of thousands if not millions of dollars uncollected given a deficient patient billing process.  Not only are facilities losing money but insurance carriers are auditing patient collection processes and issuing recoupments if the patient collection is not taking place.

SJ’s Insurance Calculator allows you to enter a patient’s insurance carrier and level of care coupled with a deductible, out-of-pocket maximums, and coinsurance rate to see what the patient’s reimbursements from their insurance carrier will be based on SJ’s vast data set collected over many years.

You can also customize the Calculator with your own data.

With our extensive reporting tools, there is no shortage of data that is made available to your facility. From claim payments to days to pay, we have you covered.