The pricing for our practices doing over $7,500 of insurance revenue is 6%. We define insurance revenue as what is contractually owed to you. This would be a combination of insurance payments and the client share (deductibles, copays and coinsurance) associated with those sessions.

There are no onboarding fee’s or hidden charges. Every month we itemize the insurance payments issued to you (see the reconciliation section for more details) and apply our 6% fee to what was contractually owed to you.

Practices doing under $7,500 of insurance revenue would be part of our GAP.

All of our contracts are month-to-month. We are proud of our current billing partnerships and we are confident enough in our success to continue to earn your business every month.

Yes, we have several teams within Appletree who specialize in different areas of serving your practice – billing, credentialing, eligibility and portal management. To keep things simple, you will have a dedicated Account Manager as your primary point of contact and go-between for the various teams. If you are having any issues or concerns, your Account Manager will be able to arrange check-ins with our respective teams to ensure that your needs are being met.

Yes, eligibility confirmations are essential in effective billing and we include this service in our full-cycle billing package. As we onboard you with Appletree we will review our workflow to ensure that we confirm coverage and client financial responsibility before all of your intakes.

Our billing specialists will be in your account multiple times every week reviewing all payments and rejections that have come in. Between your EHR and the payer portals, we will be watching rejections very closely.

On a weekly basis we run a 31-60 day claim report. This report will provide a snapshot of every insurance session in the last 31-60 days. If claims are not paid by 31 days, there will be an action plan to have those claims resolved.

The 31-60 report is available to you and your practice through your Account Manager.

Transparency is very important to us. Your invoice will be based on the monthly reconciliation sheet that your Account Manager will put together. This reconciliation sheet will be available to you and it will itemize every insurance payment that is included in the monthly billing cycle. The insurance payment will be listed with its payer, check date, amount paid and client share. This way you can ensure that you have received all of the payments we have posted into your EHR. You will also be able to see the breakdown of insurance payments plus client share going towards your contractual obligation that makes up your invoice.

For GAP participants (see services for more info), credentialing with up to 5 payers is included in your monthly rate.

For practices with less than 5 full-time clinicians, we offer credentialing projects at a significantly discounted rate of $100 per clinician per payer ($150 for Medicare/Medicaid)

For practices with 5 or more full-time clinicians, we credential all new-hire clinicians with your existing group payers at no cost. If you would like to add a new payer to the group, the cost is $50 per clinician for the new payer.

As we transition into a billing relationship, it is very common that there is some billing baggage that comes into the workflow. After all, very few practices are seeking out a new biller when everything is going well.

Claims within the last 30 days prior to your go-live date with Appletree will be automatically brought into our full-cycle workflow. We will review and refile those rejections or open balances as needed.

For claims over 30 days, we will offer a courtesy re-file one time for each date of service. Please note, this courtesy re-file does not include any substantive work on the file. We will submit the claims as-is so that their claim data can be processed through our EDI workflow for feedback.

If you would like for Appletree to work any claim that is more than 30 days before our start date, we will apply a $5/claim charge on top of the 6% fee. This is because a lot of these older claims will require additional research and possibly appeals due to their age.

Charging of client cards is not included in our full-cycle package. We ensure that your EHR has the insurance payments posted correctly so that you can be confident when charging your clients that you are charging the correct amount.

If you would like for Appletree to also process your clients credit cards, we are able to do this for an additional 1% fee (6% would become 7%). When we charge cards for a practice we run a client balance report once a week and charge all balances under an agreed upon amount. Any balance over that amount or any card that is declined will be sent to your practice for follow-up. Our card charging team does not work directly with your clients.

Authorizations are not part of our full-cycle billing package. This is primarily because most plans have removed the need for routine/clerical authorizations since Covid-19. Any authorizations that are still required by payers are very clinically driven and we have found it most appropriate for the clinician to managing these.

If your practice does require an administrative (not clinical) processing of authorizations, this can be reviewed and priced separately on either an individual authorization or hourly basis.

We are able to bill your Secondary insurance claims and the service is included in our full-cycle billing package. It is important to understand that each billing transaction is subject to the 6% fee. This is because the fee is based on the time it takes to file claims, process payments and work rejections.

Secondary claims still need to go through the same cycle the primary claims go through and they can be rejected and require additional work even after the primary has been paid. For secondary billing, the 6% will not necessarily apply to the entire contractual obligation both times, if the secondary was only for a $50 copay, the secondary 6% would only apply towards the $50.