Paradigm Behavioral Health Solutions

Commercial payer insurance compliance training can benefit healthcare organizations in numerous ways by reducing costly payer audits, increasing healthcare revenue, and helping them remain compliant with changing healthcare regulations. Through this training, healthcare providers are able to identify key performance indicators of successful healthcare organizations and differentiate between relevant policies for different payers.

Each commercial payer sets its own policies, eligibility requirements and reimbursement rates, making ongoing oversight of compliance a crucial element of healthcare operations. It is helpful for healthcare providers must remain up-to-date on changes to these regulations and implement the operational and clinical changes to adhere to the various regulations, in order to optimize their claims processing times and maximize insurance reimbursements. Disregarding commercial payer regulations can quickly lead to costly pitfalls, so healthcare providers must stay informed in order to continue providing quality care to their patients. Training and consulting with Paradigm Behavioral Health Solutions provides the regulatory guidance and operational support to remain in compliance with overarching payer standards.

The consequences for healthcare organizations that are not compliant with payer regulations can have lasting and costly repercussions. Such consequences can include receiving lower reimbursements as a result of incorrect coding; audits by third-party payers; penalties and further consequences in the event of non-compliance with government and commercial payer regulations, such as HIPAA, EKRA and false claim submissions; and decreased reimbursement rates due to inaccurate payment amount calculations. These consequences can all have a disastrous effect on bottom line performance, making it vitally important that healthcare organizations remain compliant with their respective payer guidelines regardless of their size or geographic location.

No. Paradigm Behavioral Health Solutions does not guarantee or infer any expectations related to claim reimbursements. Paradigm provides trainings, resources, and consulting services to aid in ongoing compliance and adherence to ever changing payer standards. Our years of experience at Paradigm have taught us that clinical compliance with regulated services and the appropriate documentation of said services, are positively correlated to in-network contract claim compliance as well as out of network payer regulations, claim reimbursement rates and the reduction of costly payer audits and settlements.