Stone Ridge Billing LLC

Stone Ridge Billing LLC Medical and Behavioral healthcare claims billing and A/R management. We want to be your go to Billing Office. We work the aged like there is no tomorrow.
Medical and Behavioral Health claims billing and AR management

Healthcare Revenue Cycle Management Expert - As medical billing professionals we are ready to give your receivable accounts expert care and attention. We are well versed in electronic billing, working claims denials and customer relations.


Reminder for medical and behavioral health care contracted providers: Periodically compare your most recent insurance contract fee schedule with the actual claims payment documents. Have your billing team do this.

It is quite common for insurances to process from an outdated fee schedule. This means they won’t be paying you correctly, and will warrant a call to the insurance company. Insist that any claim not processed correctly the first time – should be reprocessed using the correct fee schedule.

When I say “a” call to the insurance company – this is tongue in cheek of course, because I really mean a multitude of calls. Issues like this will need hand holding from start to finish. And there again, have your awesome billing team take care of this.

If you need of an awesome billing team – I would love to hear from you.


Here's something new-ish. Insurance companies are now creating different co-pays for PCP versus specialist. In some cases even more than two different levels of co-pay depending on what type of provider you are seeing. Something to keep in mind.

For medical and behavioral health care providers....have you checked your NPPES registry lately?  You may want to period...
NPPES NPI Registry

For medical and behavioral health care providers....have you checked your NPPES registry lately? You may want to periodically double check that all your information is listed correctly.

The NPI Registry Public Search is a free directory of all active National Provider Identifier (NPI) records. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry.


Remember to double check the reports you are running in your billing software. They do not always pull from the fields you would expect. Compare totals from a variety of different reports for the same time period and see if they make sense compared to what you think they should be saying. You might be surprised what you learn if you call tech support to ask why reports from the same time period can come up with different totals.


Demystifying the layers of state Medicaid:

It can be challenging to understand the many layers of Medicaid, the state funded insurance. Let’s demystify some of these layers. I will explain a little more about three common types of state Medicaid. There are more than three types, but for this discussion we will focus on “fee for service”, and CCO (very similar to HMO), and state Medicaid with federal Medicare.

Let me state that even though you may not have any intention to serve state Medicaid patients, a basic step in building a strong foundation for your medical or behavioral health practice is to complete the credentialing and enrollment process for state Medicaid. This will not obligate you to see state Medicaid patients. It is not a contract. It will, however, open some options for you and function as a safeguard for when you find you’ve been seeing a state Medicaid patient unknowingly. You can gain the upper edge by having that enrollment in place.

In this article I refer to “state” Medicaid and “federal” Medicare because people often get these two confused and I want to be sure you are aware they are very different and not the same coverage at all. Also, I am generally referring to Oregon Medicaid, however, Medicaid functions very similarly in every state.

A primary way I preserve my sense of humor while dealing with insurances is by adopting a game plan view. I strive towards scoring a win over the insurance companies by getting them to issue payment for provider claims. Some are more difficult than others, and when I achieve this goal I sure feel like it’s a win. I mean - “SCORE”! Am I right?

I understand these three layers like this:

Medicaid – Fee for service: Fee for Service can be viewed as a gateway, because if a provider is not credentialed and enrolled with “fee for service”, they will not be recognized as a valid provider by any of the other types of state Medicaid plans. Fee for service is often referred to as “open card”. Patients are free to seek treatment anywhere in the state, if they can find a provider who will treat them. Being on “open card” is normally very brief, usually less than a few weeks. The state Medicaid office pushes hard to roll these patients over into CCO managed care plans as quickly as possible.
Medicaid – CCO plans: These plans are very similar to HMO’s and prior authorization is often required. These are managed care plans, administered by a variety of other insurance companies, and in some cases managed by counties. Providers may request to contract with these plans and get on their panel of preferred (in network) service providers. If the panel is full, their request may be rejected. Patients have less freedom to choose who they see, as the plan they are on has a limited panel of contracted (in network) providers.

Some examples of state Medicaid CCO plans are IHN CCO (Intercommunity Health Network CCO) which is administered by Samaritan Health Plan, Jackson Care Connect CCO which is administered by CareOregon, Allcare CCO, PacificSource CCO, Trillium CCO, Willamette Valley Community Health CCO, and Healthshare CCO which further delegates plan administration to various county offices. This list can go on and on.

These plans can be difficult to identify. Watch for “CCO” anywhere on the card. Look at the policy number which will still be the patient Medicaid number. Use the state Medicaid web portal to look the patient up. If they have any form of state Medicaid plan, they should be found on this web portal.
One caveat is that Medicaid will often retro activate coverage backwards in time up to three months. You could check today and not find coverage for a patient, and you could check the same patient tomorrow and find their coverage goes back three months in time. If you have questions about what you find on the web portal, you can place a phone call. However, avoiding long hold times seems to be a thing of the past.

Medicaid in conjunction with Medicare: Sometimes state Medicaid will pay the monthly federal Medicare premium for the patient. State Medicaid could pay claims as secondary after federal Medicare pays as primary. Or, the patient could be on a federal Medicare Advantage plan (again think HMO with prior authorizations often required and limited panel or in network providers). When it comes to federal Medicare always look for the word “Advantage”. The word “Advantage” on any insurance card is going to tell you federal Medicare is in the picture. “Advantage” or “Med Advantage” always indicates federal Medicare (whether there is state Medicaid involvement or not).

Again, get very familiar and routine with using the state Medicaid web portal. Don’t be shy about calling to ask for help interpreting what you see there. Before trying to bill these claims, you would need to be credentialed and enrolled with federal Medicare, state Medicaid, and credentialed and possibly contracted with the administering insurance company. That could possibly be three enrollments just to bill one claim.

Let me reiterate, you will not be obligated by credentialing and enrolling with state Medicaid “fee for service”. However, you will then qualify for payment if you happen to see an “open card” patient. Or, you could qualify for out of network payments from a CCO plan if you discover you have unknowingly been treating a patient on one of these plans, given you obtain prior authorization. Sometimes the CCO’s will do retro prior authorizations.

Patients sometimes change insurance plans and forget to inform their provider office. If one of your existing patients switches to a state Medicaid plan, being credentialed and enrolled will allow you to be recognized as a valid provider. You could potentially see a patient many times before realizing they are on a state Medicaid plan. Depending on how far out your claims are, or who is working your aged reports, it could be a long time.

In closing, remember that credentialing and enrolling in fee for service state Medicaid will not obligate you, and is not a contract. It will provide a safeguard and open some options.
I always welcome questions. It’s easy to reach me, Holly at 503.508.5643.


Understanding Prior authorizations:

Many insurance plans require services to be authorized ahead of time. After you determine a service requires prior authorization, you will need to determine how to achieve this, as each plan is unique. Many accept phone calls, while others require you fill out and submit their own form. Sometimes there will be a web portal they prefer you to use. Be aware of your provider status with the insurance. Is the provider credentialed and contracted with that specific plan?
Insurances will issue prior authorization even when the credentialing and contracting is not in order.

Having a prior authorization does not mean the insurance is bound to cover the service. Plans will sometimes find other ways not to pay claims by stating a variety of reasons such as - the provider is not credentialed with that plan, or those services are not listed as part of the existing contract which the provider has with the insurance, or even sometimes the patient’s coverage retro-termed before the date of service occurred. So really pay attention to the overall picture and all the provider and patient details when it comes to prior authorizations.

Pre Authorizations Commonly Contain:
1. code(s) being authorized
2. start date and end date
3. number of visits allowed
4. provider name
5. patient name, date of birth, insurance policy #
6. pre-authorization number

Pre-authorizations should always be in written form. If you don’t have it in writing – it is like not having a pre-authorization because there is then no way to prove it later. Verbal is sometimes given by phone…. but then ask to receive the written document to back it up. Hopefully, the software being used will be able to track patient visits, otherwise, a staff member will need to keep track and if more visits are required it may be necessary to request another prior authorization.


The beginning two step of managing your healthcare revenue cycle (or dancing with the pay source - tongue in cheek) goes like this. When a medical or behavioral healthcare provider is intending to get claims paid by insurance companies, it begins with getting your credentialing and contracting in place with the insurances you intend to send claims to. Even if you do not intend to contact with that insurance, the credentialing still needs to be completed because the insurance company needs to know who you are. Insurance companies generally will not pay providers who are not on record with them. Credentialing achieves this. An insurance company will want to see and approve your credentials. This can take a month or longer, so it is important to start early.
Once your credentials are approved, the insurance may offer you a contract, or respond to your request for a contract. This phase can take longer, sometimes as much as three months. Until contracting is completed, you will be out of network with that company. So again, it is important to begin credentialing and contracting early if you plan to receive payment from insurance companies.


In the debate about when to submit medical claims to pay sources – daily, weekly, bimonthly. It’s good to think about this as a daily task. While it’s true that many insurances only process payments weekly, if you process and bill claims daily you will be assured a steady income. Also, you will get a chance to work the EDI edits more quickly. These edits can hold claims up and must be worked. The sooner you know what the edits are, the sooner you will be able to resolve them. In this debate, I opt for daily billing whenever I can.


Medicare is beginning to send out new medicare replace the social security numbers they've had on their insurance cards for so long. Be sure to watch for your's if you have medicare. You can also read more about this at


Stone Ridge Billing LLC is a healthcare claims billing service which can help increase your cash flow, reduce your AR – and at the same time relieve you of staffing frustrations, space rental, equipment, supplies, and administrative functions.

This company was founded by Holly Pool, a dedicated, educated healthcare revenue cycle manager. Her passion for ethical, respectful treatment of patients, clients, and their accounts has been a driving force throughout her career. Her love of organization, and joy in the victories of getting claims paid and balances reduced to zero, keep her enthusiasm fresh.

Ms. Pool has a proven record of helping companies with serious financial difficulties turn their AR around so that they have become thriving growing organizations. The rubber meets the road – in the billing department. Strong, sensible, organized processes and procedures build strong successful businesses. Tried and true, her skills, and knowledge of best practice processes and procedures are available to you.


Are you losing revenue by not having an automated billing process? We are here to help boost your end result.


Front and Back Office Consulting. Consider asking us as a consultant to collaborate with you in refining your existing policies and procedures. We combine functional expertise with practical seasoned experience, from front office to back office


An Overview Of Our Services.
- HIPAA compliant
- Post charges
- Post payments
- Analyze and resolve denials
- Appeals
- Manage patient statements and phone inquiries
- Set up payment arrangements
- Collections
- Provide financial reporting
- Consulting


Give us a call.

Are your aged reports being worked successfully?Have older balances gotten away from you?We can help!

Are your aged reports being worked successfully?
Have older balances gotten away from you?
We can help!

Medical billing can be demandingand complicated. That’s why many providers choose to take their billing needs to a trust...

Medical billing can be demanding
and complicated. That’s why many providers choose to take their billing needs to a trusted partner. We can provide solutions in an efficient and experienced manner.


Attention Medical Office Managers and Professionals. We offer quick claim submission and detailed attention to your aged reports.


Power up your practice - partner with us


Medical Billing Services

Always keeping compliance in mind.

Always keeping compliance in mind.


We are here to help boost your end result. Implementing best practice solutions for Front and Back Office.

Stone Ridge Billing LLC

Stone Ridge Billing LLC


PO Box 2404
Albany, OR

Opening Hours

Monday 09:00 - 17:00
Tuesday 09:00 - 17:00
Wednesday 09:00 - 17:00
Thursday 09:00 - 17:00
Friday 09:00 - 17:00


(503) 508-5643


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