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Medical Billing services in New Jersey

Following up on insurance claims, payer enrollments, payment posting, and outstanding balances is critical to managing these processes. Medical billing services in New Jersey support independent physicians, medical groups, and clinics of all sizes in managing their billing procedure, tracking claims that haven’t been submitted, and increasing visibility into income.
Situated in Marlton, NJ, SwiftCare Billing offers medical billing and revenue cycle assistance ranging from claims management, denials follow-up, medical coding, and payer enrollment. Prices begin at 3% of collections, and can be negotiated on a month-to-month basis with 30 days notice.
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  • 98.4% Clean Claim Rate
  • 175+ Providers
  • 50+ Specialties
  • 12+ Years Experience

Medical billing solutions in New Jersey

Medical billing encompasses a number of related tasks, including insurance verification and reimbursement follow-up. Practices may have specific functions they want to outsource, or they may opt to use wider billing support, depending on their staffing needs, claims volume and needs.

Medical billing and coding

Handle charge entry, CPT and ICD-10 coding audit, claim preparation, claim scrubbing and submission. Documentation and claim information should be reviewed prior to submission as this may help uncover errors that can slow reimbursement.

Insurance eligibility verification

Verify coverage, benefits, copayments, deductibles and authorization prior to appointments. The next step for NJ FamilyCare patients is to find out about the details of the managed-care plan; plan requirements may vary.

Denial management

Analyze reasons for denial of claims and resolve claim problems when necessary; ensure that claims are resubmitted or appealed as required. When practices monitor repeating denial patterns, it can help them uncover eligibility, coding, authorization and documentation issues.

Payment posting and A/R follow-up

Make note of any payer payments, reconcile balance, monitor any outstanding claims and schedule follow-up based on claim age and payers’ requirements.

They are a component of healthcare billing services in New Jersey and the specific services provided will vary by the practice’s needs and healthcare service agreement.

New Jersey payer rules that affect medical claims

New Jersey practices may participate in commercial insurance, Medicare and NJ FamilyCare managed care plans. Practices that have an understanding of the appropriate payers’ requirements can ensure that claims are accurately directed and managed for timely follow-up deadlines.
Five NJ FamilyCare health plans with separate requirements
New Jersey’s NJ FamilyCare program currently lists five managed-care health plans: Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan, and Wellpoint. Each plan has its own provider resources and procedures. Practices should verify the patient’s plan and the provider’s enrollment status before submitting claims.
The rules in New Jersey mandate that applicable carriers process the claims for a clean payment within 30 calendar days for claims submitted electronically and 40 calendar days for paper claims. The above comes with conditions applicable to claims under the state rules and is not applicable to all insurance products. Claim submission dates and payer responses can help practices find claims that require further work.
Personal injury protection (PIP), precertification, treatment review, and medical fee-schedule requirements may apply to auto accident claims. Employer’s Compensation is an alternative reimbursement system. Accident-related or workplace injury practices should check the insurance company responsible for the accident, the necessary authorizations and any applicable billing policies prior to submitting for a claim.
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Professional medical billing services for doctors in New Jersey

Insurance eligibility and benefits verification

Verify coverage and plan details before the visit. For NJ FamilyCare patients, confirming the specific managed-care plan helps ensure that claims are directed to the appropriate payer.

Medical coding and charge entry

Check over documentation, coding information, and charges prior to submission. CPT, ICD-10 and HCPCS codes should reflect documentation of the services provided and satisfy the requirements of the payers.

Medical claims processing services in New Jersey

Submit, process, review and follow up claims in the process of reimbursement. Organized tracking can help practices recognize missing, rejected and unpaid claims.

Denial management and appeals

Check payer explanations and denial details to see if a correction, resubmission or appeal is necessary. If recurring denial patterns occur, they may indicate that problems are occurring in eligibility, authorization, coding, or documentation.

Accounts receivable follow-up

Monitor unpaid claims by payer, age and status. Placing any priority on follow-ups based on the applicable filing deadlines can help lower the chances of any preventable timely-filing denials. Check filing limits with the current provider manual of the appropriate payer.

Patient billing and payment posting

Send explanation of benefits (EOB) and post electronic remittance advice (ERA) data, reconcile payments, and handle patient statements and outstanding balances.

Prior authorization

Monitor authorizations, submission status of related procedures and services. Requirements should always be reviewed in relation to the insurance that the patient has and what care is being received.

Payers supported in New Jersey

Medical billing requirements vary by insurer, plan type, provider contract, and specialty. Relevant payer categories in New Jersey include:
  • Medicare: Novitas Solutions processes Original Medicare Part A and Part B claims for New Jersey under Medicare Administrative Contractor Jurisdiction.
  • NJ FamilyCare: Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan, and Wellpoint.
  • Commercial insurance: Horizon Blue Cross Blue Shield of New Jersey, Aetna, Cigna, UnitedHealthcare, and AmeriHealth New Jersey, subject to confirmation of the practice's contracts and the billing provider's supported payer list.
  • Other claims: Auto personal injury protection (PIP) and workers' compensation, where these services are offered under the billing agreement.
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Medical specialties we support

Medical billing requirements differ across specialties, from documentation and coding to authorization and payer rules. Billing workflows can be adapted to the needs of a range of healthcare practices.

Mental Health

Internal Medicine

Family Practice

Wound Care

Podiatry

Cardiology

Urgent Care

Orthopedic

Laboratory Billing

Rehab Billing

Dermatology

Speech Therapy

99% Credentialing Success Rate

Our professional team has achieved a 99% credentialing success rate, helping healthcare providers complete their insurance enrollment and credentialing processes. From preparing applications to following up with payers, the team handles each step to help reduce delays and keep the process moving.

Cities We Serve Across New Jersey

Whether you operate an independent physician’s office, a specialty clinic, or a medical group with multiple locations, billing support can be arranged according to your practice’s needs.

Our medical billing services are available to practices in:
  • Newark
  • Jersey City
  • Paterson
  • Clifton
  • Hackensack
  • Bayonne
  • Hoboken
  • Passaic
  • Elizabeth
  • Morristown
  • Trenton
  • Edison
  • New Brunswick
  • Princeton
  • East Brunswick
  • Woodbridge
  • Freehold
  • Old Bridge
  • Perth Amboy
  • Hamilton
  • Marlton
  • Cherry Hill
  • Camden
  • Mount Laurel
  • Voorhees
  • Medford
  • Vineland
  • Millville
  • Atlantic City
  • Washington Township

Affordable medical billing solutions for New Jersey practices

Medical billing costs vary according to specialty, claim volume, payer mix, and the amount of work outsourced. A small independent clinic may need a different arrangement from a larger medical group handling a high volume of complex claims.
  • Pricing starts at 3% of collections.
  • Most practices pay 3%–8%, depending on their requirements.
  • Agreements are month-to-month, with 30 days' notice.
  • A free billing audit report is targeted for delivery within five business days.
A billing audit can help assess recent claim activity, identify recurring issues, and determine which billing functions may benefit from additional support.
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Billing support for your existing practice software

Medical billing must be integrated into a practice’s workflow where integration and access is possible. Clinical documentation, charge details, and other information utilized when preparing claims are stored in EHR and practice management systems.
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Faq’s

What services are included in medical billing services in New Jersey?
Common services include insurance coverage verification, coding, claim submission, accounts receivable follow-up, denial management and appeals.
Billing firms can work with Medicare, NJ FamilyCare managed care plans, or commercial carriers, based on the type of services they offer and their relationship with the carriers. Practices should validate their particular payers.
When the electronic claim is submitted, or the paper claim is mailed or left with the insured, generally clean claims will be paid or denied within 30 calendar days (and 40 calendar days for paper claims) or as required by the relevant law or claim circumstances.
How can medical billing services help reduce claim denials in New Jersey?
Billing teams can validate coverage, review coding and claim information, confirm authorization, follow up with insurers for any reimbursement problems, and track rejected claims.
The cost of the services is dependent on the specialty, volume of claims, size of the practice and the amount of support needed. Some providers may charge a percentage of collections, others may have flat monthly or per claim fees.