We at Caresmartz360 are excited to present Professional Billing Services — a specialized, end-to-end billing management solution that focuses on EVV and EDI claim submissions. Our mission is to simplify the billing process for home care agencies by ensuring accurate claim submissions, continuous tracking, and precise payment reconciliation — all managed by our experienced billing professionals.
🔹 What We Do
Professional Billing Services takes complete responsibility for your EVV and EDI claim submissions, ensuring accuracy and timeliness throughout the billing lifecycle.
Our role begins once an agency expresses interest in outsourcing its billing process. From there, our team manages the submission, monitoring, reconciliation, and payment posting of claims through your approved aggregators and clearinghouses.
🔹 Step-by-Step Process
1. Initial Contact & Onboarding
When an agency reaches out for Professional Billing Services, our team schedules an introductory meeting to understand:
The agency’s billing cycle (daily, weekly, or monthly)
The current process of claim submission
Dates of submission and any unique state-specific requirements
The preferred communication method and primary Point of Contact (POC)
The agency’s expectations from our billing partnership
After the discussion, our team provides an official start date for Professional Billing Services and begins setting up your billing workflow.
We also assign a dedicated Biller to your agency — your permanent point of contact — who manages all submissions, follow-ups, and reconciliations.
2. Authorization & Documentation
Following the initial meeting, we share the Business Associate Agreement (BAA) — a mandatory document that authorizes Professional Billing Services to manage claim submissions on behalf of your agency.
We will take the necessary authorized access that enables our billing team to review, submit, monitor, and reconcile claims as part of the billing workflow.
3. Claim Submission Process
Once onboarding is complete, Professional Billing begins managing the submission cycle:
We post EVV data to the aggregator or submit EDI claims to the clearinghouse, as per the state requirements.
After submission, we verify successful transmission and acceptance of each claim.
If a claim is rejected due to system or format errors, we promptly correct and resubmit it.
If a claim is rejected for agency-related reasons (e.g., missing authorizations or service details), we immediately inform the agency of the reason and next steps for correction.
Before each billing cycle or submission, agencies can request a pre-submission review call to verify that all claim data is accurate and ready for processing.
4. Reconciliation & Payment Posting
Once payments are received from the payers, our billing team:
Reviews and verifies each payment against the submitted claims.
Posts payments directly in your Caresmartz360 portal to keep your financial records updated.
Ensures that invoice, payment, and adjustment data remain synchronized with your system.
We also perform ongoing reconciliation to track pending claims, ensure all payments are received, and flag discrepancies for resolution.
5. Collaboration & Reporting
Professional Billing emphasizes transparent communication with every agency.
Your assigned Biller remains your main contact for any claim-related queries or follow-ups.
Monthly review meetings (based on request and availability) are conducted to discuss:
Claim performance and acceptance rates
Any recurring issues or denials
Pending claims or payment delays
Suggestions for process improvement
We ensure that all updates, issues, and resolutions are communicated promptly to maintain clarity and control over your billing operations.
🔹 What We Don’t Handle
To maintain proper division of responsibilities, Professional Billing Services:
Does not create new clients or authorizations — these remain the agency’s responsibility.
Does not generate invoices — the agency prepares and approves them before submission.
Does not make system changes without prior discussion and approval from the agency.
Our role strictly focuses on claim submission, monitoring, reconciliation, and payment posting — ensuring precision and accountability at every step.
🔹 Key Benefits of Professional Billing Services
End-to-end EVV and EDI claim submission management
Dedicated billing specialist for your agency
Real-time monitoring and resubmission of rejected claims
Transparent communication and regular reporting
Reduced administrative burden for agencies
Accurate and timely payment posting within Caresmartz360
All tasks are handled by our highly trained Billing Experts
🔹 Getting Started
To enroll in Professional Billing Services or learn more about how we can streamline your billing operations:
Contact the Caresmartz360 Support Team, or
Reach out to your Success Manager.
You can get in touch with us in the way that works best for you:
💬 Live Chat
Click the blue chat icon at the bottom-right corner of any screen within Caresmartz360 or on our Help Center.
Fastest response during business hours!
📧 Email
support@caresmartz360.com
📞 Call Us
Toll-Free: (833) 833-3135
Support Hours: Monday to Friday, 8:00 AM – 9:00 PM EST
🔹 Important Note for Faster Assistance
To help our support team assist you promptly, please mention that your inquiry is specifically about Professional Billing Services when reaching out. This helps avoid confusion with general billing questions and ensures your request is directed to the correct specialists.