Professional medical billing services in New Jersey (NJ)
The claim goes out. Two weeks later it comes back with a denial code and no check. Your biller
fixes it and sends it again. Some claims age past the filing deadline and pay nothing. We stop
that loop. We catch eligibility and coding errors before the claim leaves with help from an
in-house AI-powered workflow and an experienced team of billers. We work each denial the day
it lands.
Clean Claim Acceptance
98.4
%
Credentialing Success Supporting
99
%
Providers Nationwide.
175
+
Accurate Medical Billing
Get paid faster
Patient Billing
Predictable cash flow
SwiftCare Billing outsource medical billing services include:
Every claim passes through eight steps before you get paid. We run all of them.
We run a 270/271 check on every patient two days before the visit.
That tells us if the plan is live, what the deductible has left on it, and whether you are in network. Coverage that lapsed last month gets caught before the patient sits down.
Imaging, surgery, DME, and most infusions need the payer’s yes before you start.
We file the request, log the reference number, and call when the clock runs past the payer’s own turnaround rule. No auth on file is the reason CO-197 shows up, and CO-197 is not appealable after the fact.
Coders read the full note and pick the CPT, ICD-10, and modifier that match what you documented. Charges post the same day, so nothing sits past the payer’s timely filing window. A wrong modifier is the difference between a paid 25 and a bundled line item.
Claim scrubbing and submission
Each claim runs through an edit check before it hits the clearinghouse.
The scrubber catches NPI mismatches, missing referring provider, invalid POS, and code pairs that hit an NCCI edit.
Payment posting and reconciliation
We post ERAs line by line and key paper EOBs the same way.
Every adjustment gets the right reason code, so a contractual write-off never gets logged as a denial. Then we tie the total back to the bank deposit, so your books match the money.
Every denial carries a CARC and RARC code that says exactly what went wrong.
We sort denials by root cause, fix the ones that repeat, and file appeals with the records the payer asked for.
Most payers give you 90 to 180 days to appeal, and an unworked denial past that date is a write-off.
We work claims by aging bucket, oldest first, and call the payer instead of waiting on the portal. Every call gets a rep name, a reference number, and a date in the note.
Claims sitting past 90 days pay less often the longer they sit, so timing is the whole job.
Statements show the allowed amount, what insurance paid, and what the patient owes, in that order. We take the billing calls, set up payment plans, and explain why a deductible visit costs more in January.
Your front desk stops fielding questions it was never trained to answer.
Who benefits most from our Physician billing services
Some practices manage billing fine on their own. Others lose money every month they keep it in-house. Here is where the line usually falls.
- Solo and small practices. One biller out sick means claims stop moving. There is no backup.
- New practices. No credentialing, no billing history, no cash cushion while the first claims age out.
- Complex specialties. ABA, behavioral health, oncology, cardiology. More codes, more prior auths, more denials.
- Practices drowning in A/R. Claims past 90 days pile up because nobody has the hours to chase them.
- Practices that just lost a biller. Hiring and training takes months. The claims do not wait.
- Multi-location groups. Different sites, different habits, different results. One process fixes that.
If you have a solid biller, a simple payer mix, and clean numbers, stay put. If any of the above sounds like your week, the math changes.
Get a Free Comprehensive Medical Billing Audit
Send us 90 days of claims data. We will tell you what is getting denied, why it is happening, and what each problem is costing you per month.
- 1. You send the data. A claims export from your practice management system, or read-only access for a few days. Ninety days is enough. No contract and nothing to install.
- 2. We run your numbers. First-pass acceptance rate, days in A/R, how much is sitting past 90 days, and your top ten denial codes ranked by dollar value instead of by count.
- 3. We trace each denial to its cause. Coding, eligibility verification, a credentialing gap, a timely filing miss, or a payer rule your system is not flagging before submission.
- 4. We check the payer side. Contracted rates against what you were actually paid, plus any enrollments that are missing, pending, or expired.
- 5. You get a written report in 3 business days. Every finding is ranked by monthly dollar impact, with the specific fix and who needs to do it.
The report is yours to keep either way. If you want us to fix what we found, we will price it then. If you would rather hand the report to your current biller, that works too.
Our affordable medical billing services: what you get for the rate
We charge 3% to 8% of what we collect for you. Where you land depends on your specialty, claim volume, and how much of the work you hand over. Here is what that covers.
One rate, all the work.
Eligibility checks, coding, claim submission, payment posting, denials, follow-up. No extras added later.
Nothing to start.
No setup fee, no onboarding charge, no cost to get your payer enrollments in place.
A real person on your account.
You get a biller who knows your practice by name, not a support inbox.
We fix denials, not just report them.
Every denied claim gets corrected and sent back, with the reason it happened.
Your old claims count too.
Unpaid claims sitting from before we started get worked on at the same rate.
No long contract.
Month to month. Leave with 30 days’ notice and take your data with you.
You only pay when we collect. If we do not get you paid, we do not get paid either.
- Domain Expertise
Expert physician billing services built around your specialty
- Nationwide Footprint
A reliable medical billing company for practices across the country.
We are not only limited to New Jersey; we work with practices in all 50 states. Wherever you are, we know your payers and how they pay.
Every state has its own Medicaid rules and its own main payers. We learn and train our team before we send a single claim
Testimonials
Certified medical billing specialist on every account
Every claim we submit is handled by certified billing staff. Our team holds different active billing certifications:
- Certified Professional Biller (CPB), AAPC. Claim submission, payer follow-up, denial appeals, and accounts receivable management across the full revenue cycle.
- Certified Medical Reimbursement Specialist (CMRS), American Medical Billing Association. Insurance claim processing, reimbursement rules, and payer compliance.
- Certified Revenue Cycle Representative (CRCR), Healthcare Financial Management Association. Revenue cycle operations from patient access through claim resolution and payment posting.
Certifications are maintained through the continuing education units required by each issuing body. Credential numbers are available on request and can be verified through the AAPC, AMBA, and HFMA directories.
Ready to unlock your practice growth? Let’s talk!
Frequently asked questions
How do we know outsourcing is cheaper than our own biller?
Do the math before you look at any quote. Take your fully loaded billing cost and divide it by the rate, as a decimal. At 5%, a practice spending $95,000 a year breaks even around $1.9 million in collections.
Loaded is the part people get wrong. A biller on $70,000 really costs closer to $95,000 once you add payroll taxes, benefits, PTO, and workers’ comp. Then there’s turnover, which runs 30% to 40% a year in billing roles.
Run your number first. Then judge the percentage.
Loaded is the part people get wrong. A biller on $70,000 really costs closer to $95,000 once you add payroll taxes, benefits, PTO, and workers’ comp. Then there’s turnover, which runs 30% to 40% a year in billing roles.
Run your number first. Then judge the percentage.
Why charge a percentage instead of a flat monthly fee?
ecause it keeps us on the same side of the claim as you. If it doesn’t get paid, we don’t get paid for it.
A flat fee costs the same whether your AR is clean or sitting at 120 days. Per-claim pricing, usually $3 to $10 a claim, pays for submission rather than collection, so denials and follow-up end up being your problem or a separate charge.
Compare the total annual cost, not the headline number. A 4% quote with add-ons for statements and old AR often costs more than an all-in rate.
A flat fee costs the same whether your AR is clean or sitting at 120 days. Per-claim pricing, usually $3 to $10 a claim, pays for submission rather than collection, so denials and follow-up end up being your problem or a separate charge.
Compare the total annual cost, not the headline number. A 4% quote with add-ons for statements and old AR often costs more than an all-in rate.
How fast can you start, and what happens to claims already out there?
Two to four weeks for most practices. Week one is access and payer setup. Week two is a small test batch. Full volume once we see clean claims coming back paid, not just accepted.
Claims your current biller already sent keep adjudicating where they were filed. Leave them. What you need is a written cutoff date so nobody’s guessing who owns what, plus an aged AR list before day one.
Watch timely filing. Medicare gives you 12 months from date of service, most commercial plans less. A claim that ages out during a handoff pays nothing.
Claims your current biller already sent keep adjudicating where they were filed. Leave them. What you need is a written cutoff date so nobody’s guessing who owns what, plus an aged AR list before day one.
Watch timely filing. Medicare gives you 12 months from date of service, most commercial plans less. A claim that ages out during a handoff pays nothing.
Who can see our patient data?
Only the people working your account, under a signed business associate agreement, with access limited to what each person needs and a log of every record touched. The BAA goes in place before anyone opens a chart.
Ask any billing company three things, and get the answers in the contract rather than the sales call: where staff sit, whether any work is subcontracted further, and how fast you’d hear about a breach.
Location matters. HIPAA allows PHI to be handled outside the US, but some states restrict it and federal law bars Medicaid payments to entities based abroad.
Ask any billing company three things, and get the answers in the contract rather than the sales call: where staff sit, whether any work is subcontracted further, and how fast you’d hear about a breach.
Location matters. HIPAA allows PHI to be handled outside the US, but some states restrict it and federal law bars Medicaid payments to entities based abroad.
Do we have to change our EHR?
No. We work in the system you already have.
Any billing company that makes you switch platforms is solving its own problem. Stacking a system migration on top of a billing transition is how practices end up with two months of unbilled charges.
We need user access, clearinghouse setup, and payer portal logins. Read-only is fine for the audit. Your data stays yours either way, and you take it with you in a readable format if you leave.
What will you report, and what should we hold you to?
Five numbers every month, with the trend: net collection rate, first-pass acceptance, days in AR, how much AR is past 90 days, and denials by reason code.
Here’s what good looks like. Net collection rate above 95%, and below 93% means you’re leaking. First-pass acceptance at 90% or better. Clean claim rate over 95%. Days in AR near 35.
One warning. Collections going up while your net collection rate stays flat means volume grew, not performance. Get your baseline in writing in month one so there’s something to measure against.
Here’s what good looks like. Net collection rate above 95%, and below 93% means you’re leaking. First-pass acceptance at 90% or better. Clean claim rate over 95%. Days in AR near 35.
One warning. Collections going up while your net collection rate stays flat means volume grew, not performance. Get your baseline in writing in month one so there’s something to measure against.
If a code is wrong, who's liable?
You are. Claims go out under your NPI and your tax ID, and enforcement follows those numbers no matter who picked the code. The False Claims Act doesn’t require intent, so a pattern of errors can create exposure even when nobody meant to overbill.
Outsourcing moves the work, not the liability. That’s why credentials matter, and why it’s worth knowing that billing certifications and coding certifications aren’t the same thing.
Ask what credential the person choosing your CPT and ICD-10 codes holds. Then verify it yourself through the AAPC, AMBA, or HFMA directory.
Outsourcing moves the work, not the liability. That’s why credentials matter, and why it’s worth knowing that billing certifications and coding certifications aren’t the same thing.
Ask what credential the person choosing your CPT and ICD-10 codes holds. Then verify it yourself through the AAPC, AMBA, or HFMA directory.
What do you actually know about New Jersey payers?
More than the brochure version. New Jersey’s prompt payment rule, N.J.A.C. 11:22-1.5, gives carriers 30 calendar days to pay a clean electronic claim and 40 days on paper. Miss it and they owe 12% simple annual interest. They also have to pay the uncontested part while they argue about the rest.
Almost nobody collects that interest, because tracking it means watching the clock claim by claim.
On the payer side: Medicare Part B here runs through Novitas Solutions. NJ FamilyCare goes through Horizon NJ Health, Aetna Better Health of New Jersey, Amerigroup, UnitedHealthcare Community Plan, and WellCare, each with its own auth list and appeal path.
Treating “Medicaid” as one payer at check-in is the most expensive habit in a New Jersey front office. Verify the plan, not the program.
On the payer side: Medicare Part B here runs through Novitas Solutions. NJ FamilyCare goes through Horizon NJ Health, Aetna Better Health of New Jersey, Amerigroup, UnitedHealthcare Community Plan, and WellCare, each with its own auth list and appeal path.
Treating “Medicaid” as one payer at check-in is the most expensive habit in a New Jersey front office. Verify the plan, not the program.