Primary care billing that keeps up with the whole visit.
A routine appointment can turn into a medication review, a new concern and a conversation about next steps. Your billing should reflect the care that was actually documented. We help primary care teams connect scheduling, coverage, charges and follow-up so unfinished claims do not become another task for the front desk.
- ClaimsDocumentation review
- A/RPayer follow-up
- ReportsClear next actions
Three ways Primary Care claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- One appointment, several reasons for care
A preventive service and a problem-focused visit are not automatically two payable services. We review what was documented and check the payer requirements before reporting them separately.
- Coverage details missed at check-in
A plan may require an assigned primary care provider or a referral. We help identify those requirements early and flag discrepancies for your staff rather than let the claim reach the payer with unresolved information.
- Work between visits gets lost
Care coordination can be substantial, but not every phone call is separately billable. We review eligibility, consent and service records for the programs your practice actually operates.
What we bill for primary care teams
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Primary Care accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- Start with your appointment mix
We review your common visit types, payer mix and open claims. That shows where the handoff between scheduling, documentation and billing needs attention.
- Separate missing information from coding questions
Incomplete demographics go back to the front desk. Clinical documentation questions go to the treating team, with a clear explanation of what needs clarification.
- Track each claim to its next action
We monitor responses, work denials within the applicable deadlines and reconcile payments. Your team can see which items need its help and which are with the payer.
- Review the recurring issues together
Reports separate patient balances, payer delays and documentation holds. We discuss the patterns your team can change instead of handing over an unexplained aging report.
Included for primary care teams
- Charge review against the clinical record
- Eligibility and benefit checks within the agreed scope
- Submission and rejection follow-up
- Payer denial review and supported appeals
- Payment posting and balance reconciliation
- Aged receivable review
- Specific documentation queries for your team
- Reporting on outstanding work and next actions
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Primary Care billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Primary Care service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat primary care teams ask
Is primary care the same as family medicine?
Primary care describes a broad role in ongoing patient care. Family medicine is one specialty within it; internal medicine and pediatrics can also provide primary care. We organize the billing around your actual clinicians and services.
Can you work with our existing billing staff?
Yes. The agreed scope can cover a specific claim queue or a wider billing workflow. We define who handles each task and where questions are escalated before work begins.
Do you handle older unpaid claims?
We can review the outstanding balance, payer history and filing deadlines first. Some claims may support a correction or appeal; others may require an adjustment. We explain the next step for each group.
Let’s review your primary care billing
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.