Workers Compensation Billing & Collection | Meraki RCM Solutions




At Meraki RCM Solutions, that is what we have to offer you "the commitment to do it better" from each individual at every stage of generating revenue for your practice, hospital or medical billing office.

We have got our basics right and processes on track, industry experts on board, Technology ever best in Industry and with a mix of your guidance, we can commit to the best results ever possible!!





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Initial Process

(Patient Access Services)



Insurance Verification

RFA, Authorization


  • Daily Schedule Screening

  • Eligibility & Insurance Verification

  • Demographic Updating & New Entry

  • Complete PT. HIPPA Compliance

  • Outstanding Balance/Co-pay Collection

  • Authorization Tracking

Middle Process

(Charging & Coding Services)

Provider & Physician



Coding & Charge Entry

Claim Submission &


  • Medical Coding

  • Charge Entry and Claim Creation

  • Claim Attachments

  • Claim Submission & Clearinghouse Tracking

Business Office Services

(Account Receivable Management)

Rejection & Denial Management

 Payment Posting & Patient Billing 

 Appeal Processing & Account Resolutions 

  • A R Follow up

  • Payment Posting

  • Patient Billing

  • Appeal Processing

  • Secondary Billing

A completely seamless solution that minimizes data-entry while utilizing their guidelines and billing software. Through the creative combination of advanced technology with qualified and knowledgeable billing professionals. Our experienced billing professionals can get the claims sent to payers faster, with fewer errors and at lower costs.

  • Patient Registration & Records Updation

  • Save up to 40% as compared to your existing costs

  • Complete HIPAA Compliant process and remote access solution keeps data in your control

  • Rapid and seamless transition to Meraki RCMS Operations Centers in 30 days or less

Eligibility and benefit verification is the process where provider or his staff verify the patient policy by calling or checking on insurer website that if patient policy is active on given treatment date also the service doctor is going to provide is covered. For California Workers’ Compensation, it is to verify the injured workers claim information, accepted body parts and payer information so that your claim reaches the right party and gets paid timely.


We can take care of all your insurance verification needs and can provide you before the patient actually visits the Doctor’s office, thus minimizing the denials and better collection at first attempt.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or pre-certification. A request for authorization must be set forth on the prescribed form or format by your insurer along with the required information for Utilization Review Department at insurance to make a decision whether the medical treatment or services requested is medical necessary or not.

Meraki RCM Solutions offers this much needed service for insurance authorization as a part of the complete RCM Solutions Package.


  • Submit Authorization Requests for All Insurance Carriers

  • Assigned On-Demand Specialist

  • High Quality Insurance Authorization Service

  • We can take care of Request for authorization requests pertaining to California Workers’Compensation.

Our experienced billing professionals can get the claims sent to payers faster, with fewer errors and at lower costs. A completely seamless solution that minimizes data-entry while utilizing their guidelines and billing software. Through the creative combination of advanced technology with qualified and knowledgeable billing professionals.


  • Multi-specialty charge entry by our experienced billing professionals

  • Scrubbing of all claims before submission for fewer denials and underpayments

  • Clearing House Holds, Claim attachments, Or Paper Billing Submission

After submitting claims to insurance electronically or paper mail we track the claim with insurance company to make sure provider claims has reached the payer timely and make sure it gets paid. We track it by calling insurance companies or checking on website, we categorize Account Receivable resolution in 3 Phases.

Phase I - Initial evaluation of medical Account Receivable Follow up


We run aging report within 15-20 days of electronic claim submission to and start the follow up process, we make sure each claim has reached the right payer. We also make sure insurance company do not deny the claim for any additional information, generally private insurance companies process the claim within this time frame.

If there is any denial or insurance company has denied the claim incorrectly, we try to resolve on the call itself and document that to follow up in next 15 days.

Phase II - Analysis and prioritizing medical Account Receivable Follow up

Experienced medical A/R analysts initiate this phase by identifying the various issues for claims that are marked as uncollectible or for claims where the carrier has not paid according to its contracted rate with providers.

The filing/appeal limits of the major carriers will be checked and also the "claims submission address" will be checked for the claims to reach the correct processing unit. The team also confirms that "clean claims" will be reimbursed as per the contracted fee schedule.

Phase III - Collecting the maximum of medical Account Receivable Follow up

Based on the analysis and our team's findings, the claims that are identified to be within the filing limit of the carrier are re-filed after verifying all the necessary billing information is correct such as claims processing address and other medical billing rules.

Claims that have exceeded the filing limit of the carrier as well as the claims that appear to be underpaid by the carrier are appealed with the necessary supporting documents. Appeal procedures vary widely depending on the plan, carrier and state. These procedures are collected and applied on claims that are being appealed.

We will transmit the claims electronically directly to the carriers wherever possible and for the other carriers, claims are forwarded through clearing houses and aggressively followed up with the carrier for confirmation.

Litigation: Read more about it in Workers' Compensation and Personal Injury Billing & Collection.

Success to medical
Receivable recovery

The ultimate success of Cash Acceleration Program is dependent upon several factors:

Certainly the completeness and accuracy of the account data provided is important. Meraki RCM Solutions provides the protocols, expertise, and resources necessary to perform a comprehensive collection effort. However, the more successful programs also have received a high level of support and cooperation from the provider's office.

Our Cash Post Solution gets all our client payments posted precisely and usually within 1 business day, we can get all payments posted in the billing system accurately using cost effective solutions.


  • Experienced billing professionals post payments from EOBs, Charge Slips and other documentation

  • Secondary payer billing

  • Management and posting of denials

  • Processing write-offs and adjustments

  • Correspondence processing

  • Verification of all payments posted to reduce errors and ease reconciliation

  • Save up to 40% as compared to your existing costs.