Full Service Setup

Optimal provides physician credentialing services to private doctors, groups and ASC or hospital affiliated practices. We give providers the flexibility to choose the credentialing and enrollment package that fits their individual needs. Our customized services include:

  • Full service provider and facility setup 
  • Credentialing and enrolling
  • EMR/EHR consulting
  • ERA and EFT enrollment
  • Fee Schedules
  • Preparation & Reassestation of CAQH

Out of Network Expertise

  • Negotiations and increased reimbursements
  • Revenue and charge capture analysis
  • Quality incentive identification and implementation

Claim Review and Submission

Optimal’s reimbursement specialists review all client patient data. Billing uploads and batches are balanced, and our medical claims process software is used to 'scrub' claims for errors and omissions. Optimal’s software performs thousands of checks, including CPT/ICD-10 validations, modifier checks, demographic comparisons and payer-specific edits.

The claims review process ensures that practice billing data is being accurately captured and that claims are clean prior to being submitted for payment. Clean claims greatly increase the rate of payment, helping to maximize the amount collected and reduce accounts receivable.

Once the claims are reviewed and audited, they are transmitted to the various payers for reimbursement. Optimal has the ability to electronically transmit claims to thousands of payers nationwide.

After submission, claims receive an additional level of "scrubbing' by our clearinghouse. Edits and errors are relayed back to Optimal for correction.

Claim Tracking

Once payments have been posted into our practice management system, they are run through our payer-specific rules software, which aggressively detects unpaid claims. Once an unpaid claim is flagged, it is brought to the attention of one of our reimbursement specialists for further investigation and active follow-up.

Payment Posting

All payments will be sent directly to practice location. We recommend registering with insurance companies to get paid via EFT .Optimal will register your practice if you prefer. Once payment is received, it is reviewed and posted into our system by one of our reimbursement specialists.


While a practice may submit a perfectly clean claim to a payer, there is no guarantee that it will be reimbursed or reimbursed accurately. This frequently means that practices remain unpaid on the valuable service provided to patients. Optimal’s incentive-based, fee structure ensures that we work hard to make sure nothing gets left behind. Once an outstanding claim has been identified as past due, Optimal’s system alerts our account representative who then reviews the history and follows up on the claim accordingly. This data is reported and collected in real time.


Done on a monthly basis, our specialists provide practice performance reviews offering insight into practice financial operations. In addition, Optimal provides advanced financial and practice analysis tools designed to give enhanced visibility into practice operations at the click of a button. Practices are provided access to Optimal online, where they can access hundreds of practice analysis and performance reports.