Questions we get asked,
answered properly.

We work with healthcare organizations of different sizes, including independent physicians, small and mid-sized medical practices, multi-provider groups, multi-location practices, specialty clinics, behavioral health organizations, dental practices, and healthcare companies requiring revenue cycle support. Our services can be customized according to the size, specialty, workflow, and operational needs of each organization.

We support multiple medical specialties, including behavioral health, internal medicine, cardiology, pediatrics, nephrology, family medicine, psychiatry, OB/GYN, dermatology, urgent care, orthopedics, neurology, gastroenterology, and others. Because billing requirements vary by specialty, we review each organization’s procedures, documentation, payer mix, and billing workflow before recommending a service plan.

No. We can provide complete revenue cycle management or support selected areas of your existing process. A practice may engage us only for denial management, accounts receivable recovery, medical coding, provider credentialing, eligibility verification, payment posting, claim submission or revenue cycle auditing. We can also work alongside your internal billing team.

Yes. Exact Core Group can complement your existing team rather than replace it. We can manage specific work queues, assist with backlogs, support denial follow-up, handle credentialing, perform quality audits, or provide additional operational capacity where your internal team needs support.

No. Our team works within your existing electronic health record, practice management, clearinghouse and payer portal software. We review your current technology setup during onboarding and determine the most secure and efficient working arrangement.

Depending on the agreed scope, medical billing may include patient demographic review, insurance verification, charge entry, claim preparation, claim scrubbing, electronic claim submission, rejection correction, payment posting, denial follow-up, secondary claim submission, accounts receivable follow-up, patient balance processing, underpayment review and revenue cycle reporting. The final scope is documented before the service begins.

We do not only work denied claims after they occur — we also identify the reasons behind recurring denials. Our team reviews denial categories such as eligibility issues, authorization problems, coding errors, missing information, timely filing, medical necessity, credentialing issues, coordination of benefits, duplicate claims and modifier errors, then recommends corrective actions to reduce repeated denials.

Yes. Rejected claims are reviewed, corrected and resubmitted according to payer and clearinghouse requirements. We also track recurring rejection patterns so that the underlying registration, coding or system issue can be corrected.

Yes. We can review and work aged accounts receivable based on factors such as balance amount, claim age, payer, timely filing limits, denial reason, documentation availability and likelihood of recovery. After reviewing the aging report, we prioritize accounts with the highest recoverability and financial impact, and with the oldest dates of service.

We prioritize accounts based on claim value, age of the balance, timely filing or appeal deadlines, payer requirements, denial reason, documentation availability, previous follow-up activity and probability of successful recovery. This helps ensure the team focuses on accounts that require immediate action and have a realistic recovery opportunity.

Yes. Where expected reimbursement information is available, our team can compare payer payments with contracted or expected amounts. Potential underpayments are then reviewed, documented and followed up with the payer.

Patient billing support may be included depending on the service agreement. Services can include patient statement review, balance validation, payment inquiries, payment plan support and coordination with the practice’s patient communication policies.

Yes. Our team can contact insurance companies for claim status, denial clarification, appeal follow-up, authorization issues, credentialing updates, eligibility questions and payment-related matters. All activity is documented within the approved system or reporting process.

End-to-end medical billing, including charge entry, claim submission, payment posting, denial management, AR management and reporting on an agreed daily, weekly or monthly cycle.

We verify patient eligibility, ensure accurate coding, submit clean claims and resolve payer issues promptly — then categorise what still gets denied so the cause can be removed rather than reworked.

Yes. Exact Core Group follows HIPAA-compliant processes for handling protected health information. Controls include workforce training, role-based access, secure system access, confidentiality agreements, access monitoring and documented procedures. Specific security requirements are reviewed before system access is provided, and a Business Associate Agreement can be executed before any access to PHI.

Outsourcing can improve collections, reduce administrative cost and let clinical staff focus on patients rather than on chasing claims. Whether it is right for you depends on your payer mix, volume and what your internal team is currently able to cover.

Non-covered denials, medical necessity denials, bundling denials, eligibility denials, timely filing denials and payment disputes. Some denial types depend on the contract — authorization and coding, for example, are two separate services.

Yes. Our team prepares and submits appeals with the necessary supporting documentation, tracked against each payer’s appeal deadline.

Recovering denied claims increases reimbursement and reduces revenue loss. Identifying why they were denied is what stops the same denial recurring.

Low single digits is the usual target for a well-run practice, but the number that matters is yours and the honest answer depends on specialty and payer mix — a rate that is healthy for primary care may be poor for an interventional specialty. More useful than the headline figure is the split: which few causes account for most of it, and whether they sit in coding, eligibility or authorisation.

We follow up with insurance companies, correct claim issues, submit appeals where necessary and pursue timely reimbursement.

Yes. We work aged accounts, including claims outstanding for several months, prioritised by what is still recoverable and by which deadlines are closest.

We actively manage 30, 60, 90 and 120+ day aging accounts.

We focus on high-value claims, timely filing deadlines and claims with the highest recovery potential — deadlines first, because that is the only variable that cannot be recovered later.

Yes. Effective AR management accelerates collections and strengthens a practice’s financial position.

Yes. Detailed AR aging reports, collection metrics and recovery analysis, on an agreed schedule.

Yes, based on the documentation provided by the healthcare organization. Our coding process may include review of diagnosis codes, procedure codes, modifiers, documentation consistency and payer-specific requirements.

No. Coding must accurately reflect the services documented and performed. We do not support upcoding, misrepresentation, or any coding activity that violates payer rules or healthcare regulations. Where documentation does not support a code, we request clarification or recommend corrective action.

Our coding professionals follow current coding guidelines, payer policies and quality assurance processes.

Yes. We perform coding audits, identify inaccuracies and recommend corrections to improve claim acceptance and compliance.

Yes. We assist providers and organizations with payer enrollment and credentialing, including initial payer enrollment, provider profile review, CAQH maintenance, recredentialing, demographic updates, group enrollment, location additions, tax identification updates, EFT and ERA enrollment, application follow-up and status tracking.

Timelines vary by payer, state, specialty, application completeness and provider history. Some applications complete within several weeks; others take 90 to 180 days or longer. We track applications, follow up regularly and keep the organization informed of outstanding requirements.

No. Final approval is controlled by the payer. We can prepare applications, review them for completeness, submit required documentation and follow up consistently, but approval depends on the payer’s network needs, policies and credentialing criteria.

Yes — profile creation, updates, document uploads, attestations and consistency checks. The provider remains responsible for reviewing and approving the accuracy of what is submitted.

Yes. Verification may include confirmation of active coverage, effective dates, copay, coinsurance, deductible, remaining deductible, plan type, referral requirements, authorization requirements, coverage limitations and patient responsibility. Eligibility information is documented according to the agreed workflow.

No. It confirms the insurance information available at the time of verification. Payment may still be affected by medical necessity, coding, authorization, benefit limits, payer policies, coordination of benefits, provider enrollment or changes in coverage.

Prior authorization support may be available depending on the specialty and service agreement. The process may include identifying authorization requirements, submitting available documentation, tracking requests and following up with the payer. Clinical decisions and required medical documentation remain the responsibility of the treating provider.

Yes. Patient support improves satisfaction, reduces missed opportunities and helps ensure patients can reach your practice. This service depends on the agreed service agreement.

Appointment scheduling, rescheduling and cancellations, insurance inquiries, patient messages, prescription refill requests and general customer support. This service depends on the agreed service agreement.

Yes. Our team can provide after-hours and weekend support so patients receive timely assistance. This service depends on the agreed service agreement.

Yes. We follow HIPAA guidelines to protect patient privacy and confidential health information.

Reporting is customized to the service scope. Reports may include claims submitted, claims rejected, denials by category, denial trends, accounts receivable aging, accounts worked, payments posted, outstanding balances, payer issues, credentialing status, eligibility activity, productivity reports and key revenue cycle performance indicators. Reporting expectations are reviewed during onboarding.

Daily, weekly, monthly or on an agreed schedule. The frequency depends on service type, claim volume, practice size and management requirements.

Yes. Depending on the engagement, your organization will have an assigned point of contact responsible for communication, issue escalation, reporting and coordination with the operational team.

By email, scheduled meetings, phone, secure messaging, shared reporting tools or your own approved communication system. A monthly video meeting is standard, so we can review practice health and discuss anything outstanding. Communication procedures are agreed during onboarding.

Our support schedule is established according to the client’s needs and the agreed service plan. Confirmed working hours, time-zone coverage and escalation availability are included in the service agreement.

Exact Core Group follows HIPAA-compliant processes for handling protected health information. Our controls include workforce training, role-based access, secure system access, confidentiality agreements, access monitoring and documented procedures for handling healthcare information. Specific security requirements are reviewed before system access is provided.

Yes. A Business Associate Agreement can be executed before our team accesses protected health information or performs services that require access to PHI.

No. Please do not submit patient names, medical records, insurance details, dates of birth, Social Security numbers or other protected health information through the public website contact forms. Secure information-sharing procedures are established after the appropriate agreements are completed.