From Intake to Income – A Seamless Revenue Cycle for Nutrition Practices in California
At DelonHealth, we've built a structured, California-specific billing workflow designed to
help dietitians and nutritionists thrive. Whether you're a solo provider in Los Angeles, a
pediatric nutritionist in Sacramento, or a virtual MNT coach serving San Diego clients, our
billing process is tailored to your needs and payer mix.
Here's how we ensure clean claims, fast payments, and fewer denials—every single month:
Onboarding & Payer Analysis
We begin every client relationship with a deep dive into your current billing situation
to build a smart, customized workflow.
During onboarding, we:
• Conduct a billing system review to understand how you document, track,
and submit claims today.
• Analyze your historical claims data to identify:
• Rejected and denied claims
• Underpayments and write-offs
• Delays in submission or authorization
• Break down your payer mix, including Medi-Cal, Anthem Blue Cross, Blue
Shield of CA, Health Net, Kaiser (when billable), and others.
• Identify high-risk billing areas such as:
• MNT documentation lapses
• Telehealth modifier misuse
• Missing prior auths
• Discuss your goals: whether it's improving collections, scaling a
telehealth model, or expanding to group services.
We turn your existing process into a blueprint for optimized billing success.
HIPAA-Compliant Setup & System Integration
We configure secure, encrypted data access within 1–3 business days of onboarding
completion.
Our team:
• Sets up end-to-end HIPAA-compliant data sharing protocols
• Uses role-based access control to protect patient records
• Integrates directly with your EHR or practice management platform,
including:
• SimplePractice
• Kareo
• Office Ally
• PracticeSuite
• AdvancedMD
• Custom or niche platforms
• Configures workflow rules around:
• Visit types and charge entry
• Claims queue reviews
• Clinical documentation expectations
• Coding reviews for CPT/ICD alignment
This ensures secure and efficient setup with minimal disruption to your team.
Real-Time Insurance Eligibility Checks
Before each scheduled appointment, our verification team runs live eligibility checks
with your patients' insurance carriers.
We confirm:
• Active insurance coverage with Medi-Cal, commercial plans, or exchanges
• Effective date range and plan tier details (HMO, PPO, EPO)
• Covered services based on patient diagnosis (e.g., MNT for diabetes,
obesity, CKD)
• Frequency and visit limits, especially for preventive counseling or
telehealth
• Out-of-pocket obligations like deductibles, copays, or coinsurance
• Referral or prior authorization requirements
If we detect an issue, we notify your front office or virtual assistant
immediately—preventing last-minute surprises and reducing claim denials at the source.
Fast, Clean Claim Submission
Once services are delivered and encounter documentation is complete, our team begins
preparing your claims for submission.
We submit all claims within 24–48 hours, using:
• Correct CPT/ICD-10 codes for MNT, preventive counseling, group sessions,
and more
• Modifiers (95, GT, etc.) for virtual services when applicable
• POS (Place of Service) codes to match in-person vs. telehealth billing
• Payer-specific formatting rules, including CA Medi-Cal and Blue Shield
routing logic
• Secure clearinghouse tools to verify claims pre-submission and catch
formatting errors
Our clean claim rate helps reduce denials and improves your first-pass
resolution—keeping your cash flow smooth and reliable.
Appeals & Denial Management
When a claim is denied or underpaid, we don't wait—we act.
Our denial management process includes:
• Reviewing Explanation of Benefits (EOB) or denial codes to find the root
cause
• Reaching out to the payer (e.g., Anthem CA, Health Net, Medi-Cal MCO) to
request clarification if needed
• Preparing customized appeal letters that clearly outline:
• The billed service
• The medical necessity
• Supporting documentation from your charts or referrals
• Attaching authorization records, referral forms, or clinical notes as
supporting evidence
• Resubmitting corrected claims with updated codes, modifiers, or missing
details
We track each appeal and ensure consistent follow-up until the issue is resolved—you
never lose track of your revenue.
Payment Posting & A/R Monitoring
Once claims are paid, we perform full payment posting and accounts reconciliation to
ensure your books are accurate and up to date.
We:
• Post ERAs (Electronic Remittance Advice) and manually enter any paper
EOBs
• Match payments to billed amounts and track any underpaid claims or
write-offs
• Submit secondary insurance claims if applicable (e.g., Medicare +
Medigap)
• Identify aged accounts and initiate internal workflows to chase down
unresolved balances
• Flag patient balances, copays, or coinsurance for statement generation
and follow-up
We also reconcile bank deposits with your billing system to ensure 100% alignment.
Monthly Performance Reviews & Strategy Sessions
Every month, we send you a comprehensive billing report and meet with you (virtually) to
review KPIs and improvement opportunities.
Reports include:
• Collection summaries (total charges vs. payments vs. adjustments)
• Denial rates and top denial reasons
• A/R aging analysis broken down by date of service and payer
• Top-performing services and codes by reimbursement amount
• Missed revenue opportunities, such as unbilled services or recurring
documentation issues
Your dedicated account manager walks you through the numbers and helps you:
• Address coding or documentation trends
• Reduce patient AR issues
• Improve claim velocity and payer response time
• Identify opportunities to optimize or expand services (e.g., group
visits, hybrid billing, added payers)
These monthly reviews are like having a billing strategist on your team—not just a
vendor processing claims.
The Result?
A faster, cleaner, more profitable revenue cycle built just for California dietitians
and nutrition providers.
Whether you're billing for:
• In-person visits
• Telehealth counseling
• Group nutrition sessions
• MNT for diabetes, CKD, obesity, or eating disorder
Our billing workflow adapts to your clinical and business needs—so you can focus on your
patients, not your paperwork.