This document outlines the basic steps and requirements for setting up a medical billing project between an India-based operations team and a US-based provider. It includes: 1. Necessary infrastructure for the India team such as medical billing software, servers, phones, and internet access. 2. Details on selecting billing software that can track unpaid claims and customized reporting. 3. The process for insurance enrollment including Medicare, Blue Cross, and Blue Shield. 4. Requirements for provider information needed from the US team. 5. Procedures for transmitting patient data from the US to India team through fax and email. 6. Roles for the India and US teams in claim processing, printing,

1. Medical Billing Project
Basic Steps to Start Process
1. Infrastructure………………………………………….
2. Medical Billing Software……………………………..
3. EDI Enrollment……………………………………….
4. Requirement from Provider End……………………...
5. Data Migration Procedure…………………………….
6. India-US roles………………………………………….
7. India Operation Set up Flow Chart…………………….
8. Data Transmission/ Work Execution Flow Chart………

2. 1. INFRASTRUCTURE
There are few basic requirements to start Medical Billing Project in
initial stage
1. Medical Billing Software
2. Server
3. Telephone set and Head phone
4. High speed Internet line
5. Computers,
6. Printer
7. Scanner
8. E Fax Number- Should have facility of sending claims
9. Stationary

3. 2. MEDICAL BILLING SOFTWARE
Medical Billing Software should have complete Medical Billing Package which includes
everything from Patient Scheduling, Claim Processing to AR Follow-up. There are lots of
software in Market but only few softwares have complete package and easy to handle.
Claim processing is not a big task in any software but when question of tracking of
unpaid claims comes in picture then lots of software get failed to fulfill that requirement.
I have seen such cases where company have good software but to keep track of Unpaid
claims, for AR purpose, they are attaching another software with it and taking data from
primary software in every 24 hours. This process is very tedious. This condition is ok if
any other software cannot fulfill the requirement of our billing.
In our situation, we have to work for Medical Doctors and this is not as complicated as
Workers Com and No Fault billing and other different type of billings.
Sequel Med Software
Sequel med Software is complete package in itself. It has following Primary features
which are required
1. Patient Schedular
2. Documentation
3. Claim Processing
4. Payment Processing
5. AR Followup
6. Reports
I prefer Sequel med for the following reasons.
1. Tracking of Claims: Claims can be easily tracked in this software. This software
has facility of bunching all claims received in a single fax or received for a day
for every doctor in a single folder called Batch. With this facility we can searched
out documents, we have, related with this claim.
2. Good AR Follow-up Facility: Claims can be easily tracked claims and bifurcate in
different groups as per the requirement. By this we can easily track the claims and
stop our self by doing duplicate work. This way we save our time.
3. Customized Reporting: We received reports here in Pdf as well as in Excel
Sheets. We can easily customized the reports as per the requirement

4. 3. EDI ENROLLMENT
We have Medical Doctors and almost 90% claims for these doctors will be processed
electronically. We need clearing house to process these claims. In case of Sequel med
they have contract with Emdeon Clearing house, so we will get this facility with the
software we purchase.
Emdeon will process only Commercial Claims. For following Insurances we, as a billing
company, need to setup EDI directly with them. Sequel med will help us regarding it.
They are as follows.
1. Medicare
2. Blue Cross
3. Blue Shield
Process of EDI Enrollment with these companies
1. We as a billing company need to setup ourself with these companies. They will
provide us Submitter id.
2. In future, we can add many more doctors and start their work easily.
3. With request for Submitter Id, we have to provide information of one doctor and
software information also. All these information we have to provide them through
preprinted forms they will provide us.
4. Insurance company will ratify the information. In case of any query they will call
the contact person.
5. Next step is Claim testing. This testing is a process from insurance company
which is required to check the compatibility of software with their software.
6. Once our claims pass the Testing phase they will put us Production. That means
we can send our claims electronically now.
Time Taken by this process
Normally this process takes minimum 15 working days to 25 working days but I can not
say about the workload of EDI request in the insurance end. But Yes we can send
commercial claims probably with in 7 to 10 days after provider profile is created in the
software.

5. 4. REQUIREMENT FROM PROVIDER END
Provider Information is the must to process the claims. We Need Provider information for
following reasons.
1. To Set up Profile in Software
2. Dealing with Insurance company
3. For AR Purpose.
I am attaching the excel sheet which have all the information we need from provider.
Broadly this excel sheet has following information
1. Practice and Provider Information
2. Provider Tax id and NPI
3. Provider Identification Numbers provided by all the insurances to Provider
4. Location Information where service is provided

6. 5. DATA MIGRATION PROCEDURE
Data will be transmitted from Client to India Operation by following way
India Operation will Provide Fax number to Client (Provider) for smooth Processing of
Data Migration. With this, India Operation will do the following so that you can keep tab
on proper migration.
Process of Sending Data
1. Please organize the data in following categories (if Possible)
a. Demographics
b. Charge Sheets/ Super bills
c. EOBs
d. Denials
2. Please Organize batches of maximum 20 pages and attach Batch Cover Sheet
(Available in the end of the document), provided by India Operation, on every
Batch. It would be easy to keep tab on data outsourced.
3. Please assign serial no. on every batch.Serial Number should be assigned in
every batch in the 5 DIGIT FORMAT in following way
CLIENT
(PROVIDER)
FAX INDIA
OPERATION
DOCS
DEPARTMENT
Email
DATA TRANSMISSION PROCESS

7. 1st
and 2nd Digit- Indicate Month as 01 for January
3rd , 4th
, 5th
Digit – Indicate serial number as 001 onwards
4. Please fax these batches one by one on the provided fax number.
5. On receipt of fax, India Operation will send you an acknowledgement by
email. Even if data is not legible (not scanned properly or data missing) India
Operation will inform you promptly by Email. Please re-fax the same
immediately with the copy of Acknowledgement Email attached with the
batch.
6. Problem log will be sent to client on daily basis with complete explanation via
E Mail or fax. Please fax the requested data within 48 hrs with a copy of
Problem log Attached with the requested data.

8. 6. INDIA – US ROLES
Role played by India Team
1. Eligibility Verification (if Required, we need calling Person to take this task)
2. Patient Registration
3. Claim Processing
4. Payment and Denial Handling
5. Account Receivable (Calling team Part)
6. Reporting
7. Client Interaction
Role Played by US Team
1. To Print Paper claims on HCFA 1500 form and to send them to correct
Insurance address by Post.
2. To Print the Patient Statements and post them at the right patient address.
US office need to purchase HCFA 1500 forms to solve this purpose.
This is the initial setup I am talking about. Gradually we will upgrade ourself.

9. 7. INDIA OPERATION SETUP FLOW CHART
Client (Medical
Providers)
US Department
India Operation
Document Mgmt dept
Eligibility Verification
Dept/Pre Auth
Claim Processing
Dept
Pymt/Denials Dept
Practice
Mangement
Software
EDI Dept
Clearing
House
AR Dept
Insurance
Company

10. 8. Data Transmission/Work Execution Flowchart
Execution of All Medical billing Services provided by India operation can easily be under stood
by given below flowchart.
CLIENT
Work will be received by
India operation through
Efax/FTP
Docs Mgmt Dept is
responsible for receiving and
distriubuting the work to
other concerned dept
Practice
Mangement
Software
Eligibility
Verification/
Pre auth
Claim
filing Dept
Payment
Management
Dept
Patient Billing
Management
Dept
PATIENT
AR dept
will work on
F/u claims
Insurance
Company
Indicator of Revenue
Indicator of Problem log Alerts sent by India Operation
Indicator of India operaton Work Execution