Registration

Initially, your practice must be set up with our services and a clearinghouse and/or carrier. The price of registration includes processing your registration for our services, applying for your EMC (Electronic Media Claims) approval, reviewing in-house forms (superbill, new patient info, etc) to ensure they contain all required fields, and loading your practices’ information into a database created specifically for you.  This is a one-time, non-refundable charge, which may vary between clients.  Here is a list of the information we will need to process your registration and create your database:

• Registration form & fee

• Contract for ChiliMBS services

• A W-4 Form for each provider on staff:  2001 Form W-4 Employee's Withholding Allowance Certificate

• A W-9 Form: 1200 Form W-9 Request for Taxpayer Identification Number and Certification.pdf

• List of participating carriers, if available

• A copy of your current New Patient Information Form

• A sample of your current Superbill/Treatment Form

• The practice's Fee Schedule (procedural fees, as well as any in-house fees for missed appointments or cancellations, etc.).

• EMC Agreements:  (approval for EMC privileges is 2-3 days for most commercial carriers, and up to six weeks for government carriers).

  • New York Providers, who participate with any of the carriers listed below, must sign an EMC Agreement for that carrier to submit claims electronically.  The EMC Agreements will be sent to your office once your registration has been completed.

    • Preferred Care

    • BCBS of Rochester (Includes Blue Choice)

    • United Healthcare Railroad Medicare

    • Empire Medicare

    • GHI Medicare - Borough of Queens

    • Upstate/Western NY Medicare

    • Medicaid Management Information System

    • BCBS - Empire Blue Shield

    • BCBS of Central NY

    • BCBS of Utica-Watertown/Quicklink

    • General Health Inc (GHI) In and out of network

    • Champus

    • TRICARE

  • All Other States:  A complete listing of carriers which require the provider to sign an EMC Agreement will be provided to you once we have received your registration, or you can contact our office for further assistance.

  • All Payors List - contact our office to request any additional information on which carriers are set up with our clearinghouse...ET&T Clearinghouse. 

• Participating Insurance Carrier Billing Manuals and/or Guidelines, if available.  (If your office does not have a copy of these manuals, we will request them for you).

*All patient inquires should continue to be directed to your office, unless you have contracted for ChiliMBS Support Services, your practice phone number will therefore appear on all patients statements generated out of our office on your behalf.

Weekly Submittal Envelopes

All clients must provide us with the information required, in order to set up your account, create and maintain your patient database, and to generate each claim as required by the named insurance carrier.  ChiliMBS provides all of our clients with written guidelines to assist them in gathering billing information which we will need in order to process your claims, as well as our optional Support Services.

• Submittal Envelopes should be delivered to our office on a weekly basis, consistently on the same day of each week.  Some of the most common methods used are:  standard mail services, overnight services, faxing documents, or a courier service.  Shipping and handling expenses are the responsibility of our Clients, unless otherwise specified in your contract.  (ChiliMBS Courier Services are available to all Rochester, NY area physicians, for more information please see our "Additional Services").

• Any claim, which is missing required information, will be reported to your office as being "Incomplete". Incomplete claims need to be corrected and resubmitted to our office.  Additional fees may be applied to those clients whose submittal envelopes are consistently not in compliance with the requirements set forth, and agreed upon, in our service contract.

Claims Filing Only (Without Follow-up) 

• Entering and submitting primary and secondary claims, per date of service.

• Posting of payments only on primary claims requiring a secondary billing.

• Submitted Claims Report that includes claim detail as well as information needed in order to perform in-house tracking of claims.

Full Service Billing (Insurance & Patient) & Practice Management (With Follow-up)

We offer our clients a customized Flat Monthly Rate.  Please see "Compare" expenses for more information.

Full Billing Services Include the following:

• Entering and submitting primary and secondary commercial claims, up to six CPT lines per date of service.

• Entering and submitting Monthly Workers Compensation Claims with required attachments.

• Entering and submitting Monthly Motor Vehicle Accident Claims with required attachments.

• Following up with insurance carriers and/or the clearinghouse to assure claims have been accepted.

• Calling insurance carriers to check the status of your claims.

• Posting payments to your insurance claims or self pay patient accounts.

• Tracking unpaid procedures and sending Letters of Medical Necessity when necessary.

• Resubmitting claims to an insurance carrier, upon request.

• Notification to our clients regarding any "Incomplete Claims" which were unable to be processed as a result, or when additional information is required by the insurance carrier to adjudicate your claims.

• Generating patient statements (paper) on a monthly basis to any patient with a balance due of $2.50 or more.
  • This shall include any balance due remaining after the insurance carrier has made payment, and if balance billing is permitted in the provider’s agreement with them.
  • While routine waivers of co-payments is not advised, if a patient has not paid their co-payment at the time of service a patient statement will be generated and an additional $5 processing fee will automatically be applied to that patient's account.  Patients are informed in advance of this fee, if you choose to utilize our version of the New Patient Information Form.  Otherwise, a sign should also be posted near the reception area.
  • Patient Billing also includes generating statements on a monthly basis to any uninsured (self-pay) patient who has not paid at the time of service. This can also include those patients who are placed on a payment plan.
  • ChiliMBS uses a soft" collection method with patients, and will continue to work with any patient that has a patient due until instructed to do otherwise by the Client (usually turned over to a collection agency or written off after a 90 day period).
  • We encourage all of our clients to establish a merchant account (MC, Visa, etc), if not done already.  By offering your patients alternative payment methods (cash, check, credit card, payment plans) you will greatly increase the odds of receiving immediate reimbursement.  You will also decrease the odds of incurring additional expenses associated with collection agencies (which can as much as 50% of the bill)!
• End of Month Reports that reflect: Claims Submitted, Accounts Receivable Aging, Practice Analysis, and Unable To Bill Out Report (a list of patients who require attention and/or additional information).

Additional Services

Verification of Benefits

• Verifying benefits before a patient is seen in the provider's office is vital to any practice, and an essential step to ensure reimbursement from insurance carrier's.  Knowing how a claim is going to be potentially paid will bring you one step ahead in the reimbursement game. Ideally performed in-house, ChiliMBS offer this service to those practices who are insufficiently staffed to handle this task.

A/R Recovery (an increased registration fee is applied, varies among clients) 

• Before writing off old claims which remain unpaid, ChiliMBS will exhaust every avenue available to attempt the collection of monies due on claims previously submitted and uncollected.  (*NOTE:  If you are contracting with ChiliMBS for Full Billing & Practice Management services, this would apply to any previously submitted, and unpaid claims, prior to our contract with you).

• Our fees for this service are customized to meet with your specific needs.

Support Services 

Includes telephone calls to and from our office from our clients staff and/or patients. Most of these types of calls are concerning patient accounts, insurance questions, etc., and can take up a great deal of our staff’s time in certain situations.  Therefore, ChiliMBS offers the following support services:

• Clients & Staff Members - free email, Internet, and phone support services

• Patients - we offer our clients the following choices for patient inquires:

  • Inquiries to be continued to be directed to the provider's office, with the provider's office phone number listed on all statements.

  • Contract with ChiliMBS for Patient Support Services, which will be included in your customized Flat Monthly Rate.  When choosing this option, the ChiliMBS local phone number will appear on your patient statements, and all patient inquires made to your office can be redirected to ChiliMBS for prompt assistance.  (*Note:  arrange for call forwarding, for an invisible transition to our office).  Email & Internet support is included.

• Toll Free Line - while this is available to all of our out of area clients free of charge, when used for patient inquires this service is only available for an additional fee.  The toll free number will appear on all patient statements.

Courier Services (Rochester, NY area clients only)

• Consistently sending your Weekly Submittal Envelopes to ChiliMBS is an important factor when outsourcing!  We offer local clients the option of utilizing our courier services, which will pick up your Weekly Submittal Envelopes and deliver them to our office on the same day!

Web Site Design & Hosting (Clients Only) 

• Limited to one page, additional pages can be included for an additional fee

• Updates are posted for an additional fee with each occurrence

• Hosting is available for an additional fee

Patient Birthday Cards

• Sending your patients birthday cards is a wonderful way to strengthen your relationship with them, promote referrals, and to promote repeat business.  ChiliMBS is proud to offer this valuable service!

Form Creation

• Customized Superbills, Insurance Verification, Patient Birthday Cards, New Patient Registration forms, etc. Price includes the original master copy only, additional copies are available for an additional fee.

Customized Reports

• ChiliMBS has the ability to create a variety of customized reports, using your database of information.  Some of these reports might include a Birthday Report, Payment Analysis Report, or  an Encounter Analysis Report for example.

Consulting

• ChiliMBS provides a variety of consulting services, including training front office staff, fee schedule reviews, coding reviews, form reviews, etc.

• Choice of hourly or per day rates.