A small sampling of what we've been working on at Ambiki lately:
- Per-payer provider taxonomy overrides.
- Billing the exact same visit as 92507 to one payer and G0153 U1 in 15-minute units to another.
- Making sure Early Intervention eligibility is checked on the date of service, not whether the coverage happens to be active today.
- Handling DMAS limits of six units per child, per code, per practitioner, per day.
- Making secondary claims report the procedure code and units the previous payer actually adjudicated.
- Correctly handling $0 ERAs where claims were actually paid but the cash was offset by provider-level adjustments.
- Handling a payer recouping and re-paying the same service under a different claim control number on the same remittance.
- Untangling what a patient actually owes when there's a copay, a prepayment, a write-off, multiple payers, and adjudication happens out of order.
- Applying Medicare's 8-minute rule across the total OT/PT session instead of calculating each line independently.
- Building out 837I / UB-04 institutional claims, including NUBC revenue codes and payer-specific type-of-bill rules.
- Making sure a 23-month-old shows up as "1 year, 11 months old" on an evaluation instead of simply "1 year old."
- Making sure we don't text an appointment reminder to a parent who is already sitting in the waiting room.
For most of you, that list is probably gobbledygook. A word salad of 837s, taxonomy codes, adjudication rules, units, modifiers, and acronyms.
Even for people in the industry, a decent portion of it is probably still gobbledygook.
I actually find that pretty exciting. Ambiki has matured to the point where more and more of the work is in these details.
Not just "Can the software submit a claim?" But: "What happens when the secondary payer wants a different code, the primary adjudicated five months late, the patient already paid their copay, and the remittance arrives in an order nobody expected?"
The devil is in the details and these are exactly the kinds of details that move the meter for large speech therapy private practices.
If you run a speech therapy private practice and your current software makes you work around these kinds of details instead of handling them for you, I'd love to show you what we're building at Ambiki.