Cardialogy Billing provides Hawaii-based cardiologists with coding, claims, authorizations and follow-up. Workflows are based on local plans, referrals from other islands and a payer mix unique to Hawaii.
Built around coverage checks, coding review, authorization tracking, and steady A/R follow-up.
The majority of mainland cardiology practices manage a few national payers. Hawaii is unique. On Oahu, military families add a TRICARE layer, local plans bear a significant portion of the burden, and companies are required to provide coverage to individuals working as few as 20 hours per week.
Across the islands, we bill general cardiologists, interventional teams, electrophysiology offices, and imaging facilities. Each claim is checked against the member's real plan before it goes out, because a wrong payer in Hawaii usually means a rejected claim and weeks lost.
Coverage here can alter with a person’s work.Employer changes carriers or hours are cut, spouse's plan kicks in. Before an echo or surgery or stress test, we review the active plan, your cardiologist’s network status and any referral or authorization step.
Hawaii's insurance market has a few features that billing teams on the mainland rarely see. Knowing them helps us catch coverage problems before a claim is filed.
Hawaii’s Prepaid Health Care Act mandates that most firms cover employees who work at least 20 hours a week for four straight weeks. Employees can decline such coverage if insured elsewhere, therefore a patient’s plan on file can be out of current by the next appointment.
Large military presence in Oahu, many cardiology schedules have TRICARE patients, retirees and family members. Commercial insurance does not, however TRICARE does have particular authorization and referral requirements for claims.
Each plan has its own provider manual, portal, and authorization habits. We keep them straight so your staff does not have to.
The state's largest local carrier, with commercial, Medicare Advantage, and other product lines. We confirm which product the patient holds before routing the claim.
An integrated system where most care stays in-network. We check referral approval before outside cardiology services are scheduled.
A Hawaii-based plan serving employer groups. We follow its provider rules and claim submission steps for each service.
A local plan serving many employer groups across the islands. We verify group-level benefits and any plan-specific approval needs.
Since Medicaid recipients in Hawaii are enrolled in a health plan, billing is sent to the plan rather than a single state payer. After determining the plan, we proceed with its network and permission procedures.
The practice runs the danger of scheduling a catheterization, nuclear research, or device implant without an approved procedure. In order to obtain approvals prior to the patient's arrival, we operate from the schedule forward.
A cardiologist's order or scheduled procedure reaches our team.
We find out what the plan currently requires for that particular service.
We compile the test findings, notes, and diagnosis information that the reviewer will request
We log the reference number and send via the plan's channel.
Before filing, the claim's codes, units, and dates are compared to the approval.
Hawaii standard time remains unchanged throughout the year. The distance moves in tandem with changes in the continent. We schedule same-day submissions and follow-up calls around mainland payer call centers' and clearinghouse cutoffs' clocks rather than Hawaii office hours.
Cardiology will pay or deny based on minor differences like which component was billed, which modifier was used and if the treatment and visit were properly separated.
Echocardiograms, stress tests, and nuclear studies might be billed as a global service, professional component only, or technical component only, depending on who controls the equipment and where the study is read. The same code will be billed differently on various days by a practice that owns its in-office equipment and reads studies at a hospital. We set up each location correctly.
Cath, stent, and device work depends on exact code selection and documentation. Pacemaker checks and remote monitoring have separate codes for in-person and remote interrogation, which matters for practices following patients across islands.
Oahu, Hawaii’s heart care center. Patients from Kauaʻi, Maui and Hawaiʻi Island frequently come to Oahu for electrophysiology advanced procedures or structural cardiac surgery. After treatment they return home for follow-up appointments.
Additionally, several cardiologists have clinics on multiple islands. This has an impact on the site of service, the rendering provider, the billing location, and the facility that the claim is associated with. Another layer is added by remote device checks and telehealth follow-ups.
We get the right result on Oahu, and we get the right result on Maui because we keep each interaction attached to the right place and the right supplier and the right plan.
A plan cannot pay a cardiologist who is not properly enrolled. We take care of the paperwork for new people and new sites that keep providers active in Medicare, private insurance and Hawaii’s Medicaid health plans.
Track renewal dates for each provider.
Keep the shared profile accurate and attested.
Match practice details to the national registry.
Record privileges at each island facility.
Link providers to the right billing group.
Calendar Medicare and plan renewal cycles.
Medicare covers cardiology services according to a geographically varying fee plan. Hawaii shares one payment locality with Guam. Every practice in the state uses the same Medicare rate table.
Medicare reimbursements are compared to the permitted amount for each code in the Hawaii area. We investigate whether a low payment is due to a processing fault, a coding problem, or a modifier issue, and we file an appeal if the claim is valid.
A lot of Medicare beneficiaries have a Medicare Advantage plan or a supplement. We make sure secondary claims cross over appropriately, verify which one applies, and only bill patients for the amount that is actually theirs. .
These are the problems we see most often, and the checks we run to catch them early.
Employer plans change and patients don’t always tell the front desk.We recheck active coverage at each visit.
Referrals and permissions are different for HMSA, Kaiser, UHA and HMAA. One plan’s steps may founder on another.
If a patient is seen on Oahu and then again on Maui, each claim must have the correct location and provider.
Late-day Hawaii work can miss mainland payer cutoffs. We schedule submissions with that in mind.
These services require accurate place of service, modifiers and plan specific coverage checks.
Multi-location providers need matching information in every payer system, or claims rejected.
We follow you through the complete billing cycle, from the first coverage check to the last unpaid debt.
Confirm active coverage, network status, and approval needs before each visit.
Assign CPT, HCPCS, and ICD-10-CM codes with the right modifiers and units.
Compare charges to documentation so nothing is missed or billed twice.
Send claims to the correct payer, whether commercial, Medicare, Medicaid, or TRICARE.
Find out the reason for each denial. Appeal when the record supports it.
Handle your cardiologist’s plan applications, changes and renewals.
Each area has its own codes, documentation, and payer questions. We assign work to people who know the difference.
Office visits, ECGs, and preventive care
Cath, angioplasty, and stent procedures
Ablations, pacemakers, and defibrillators
Echo, stress testing, and nuclear studies
Supervised rehab sessions and ongoing clinic visits
Every step has an owner and a check, so problems show up early instead of at the denial stage.
Look ahead at upcoming visits and procedures.
Verify active insurance and benefits.
Identify the exact plan and product.
Confirm referrals and provider participation.
Request and log approvals where required.
Collect charges from the visit or procedure.
Match codes and modifiers to the record.
Fix errors before the claim leaves our system.
Send to the payer or clearinghouse.
Post remittances and patient balances.
Trace each denial to its cause and respond.
Work aging balances and reports on open accounts.
These questions come up on a large share of cardiology claims in the state. Answering them first prevents most avoidable rejections.
Cardiology billing takes constant attention to coding and payer rules. When it sits on the shoulders of a small office team, mistakes and backlogs pile up. Our team takes that work off your hands and reports back on results.
Answers to what Hawaii practices ask us most.
From coverage checks and approvals to coding, Medicare, TRICARE, and aging claims, our team can take over the billing work that keeps pulling your staff away from patients.
Start with a look at how your billing runs today.