Claims & Billing Policy

Cari provides comprehensive billing and claims management features for healthcare providers. This policy outlines our commitments regarding claims processing, reimbursement, and dispute resolution.

2.1 Electronic Claims Submission

Our Platform supports electronic submission of insurance claims to major payers, including:

2.2 Processing Times

Claims are typically processed within the following timeframes:

2.3 Claims Requirements

To ensure timely processing, all claims must include:

• Complete patient demographic information
• Valid insurance/payer information
• Accurate diagnosis codes (ICD-10)
• Procedure codes (CPT, HCPCS)
• Provider NPI and billing information
• Supporting documentation as required

3.1 Payment Processing

Once claims are adjudicated by payers, reimbursement is processed according to the payment terms of each specific payer. Funds are deposited directly into the provider's designated bank account.

3.2 Payer Reimbursement Rates

Reimbursement rates are determined by the insurance payer, not by Cari. We cannot guarantee specific reimbursement amounts and recommend verifying payer fee schedules independently.

3.3 Patient Payments

The Platform supports collection of patient responsibilities including copays, coinsurance, and deductibles through multiple payment methods:

4.1 Common Denial Reasons

Common reasons for claim denials include:

• Missing or invalid patient information
• Invalid insurance eligibility
• Services not covered under the patient's plan
• Missing or incorrect coding
• Timely filing deadlines exceeded
• Duplicate submissions
• Requires prior authorization

4.2 Denial Management Tools

Our Platform provides tools to:

5.1 Internal Review Process

If you believe a claim has been incorrectly denied or processed, you may initiate a dispute through:

5.2 Dispute Timeline

5.3 Appealing Denials

When filing an appeal:

• Include the original claim number and denial reason
• Provide supporting documentation
• Include a clear explanation of why the claim should be paid
• Submit within the payer's appeal deadline (typically 30-90 days)

6.1 Provider Refunds

If a payer requests a refund of previously paid claims, the provider is responsible for repaying the amount. Our Platform will notify you of any refund requests and may deduct amounts from future payments.

6.2 Patient Refunds

If a patient has been overcharged, refunds are processed within 5-7 business days through the original payment method.

7.1 Platform Fees

Cari charges the following fees for claims processing:

7.2 Transaction Fees

The Platform provides comprehensive reporting including:

Our billing support team is available to assist with:

• Claims submission questions
• Denial assistance and appeals
• Payment reconciliation
• Technical issues
• Training on billing features