Allergy and Immunology Billing Services
Specialized billing for allergists & immunologists fewer denials, faster cash flow, compliance you can trust.
Running an allergy or immunology practice means juggling complex testing protocols, vial preparation, and therapy schedules while also managing insurance rules that change by payer and procedure. At Sirius Solutions Global, we take the billing burden off your team so you can focus on patient care. Our allergy-specialist coders, clinical-trained billers, and compliance workflows are built to minimize denials, increase first-pass acceptance, and accelerate reimbursements.
What we deliver full-cycle allergy & immunology revenue cycle management
We don’t just submit claims. We own the outcome.
1) Front-end: eligibility & pre-authorization
Verify coverage, benefits, deductibles, and whether immunotherapy or certain testing is covered.
Pre-authorize complex procedures and notify staff/patients about expected patient responsibility.
Flag Medicare/Medicaid exclusions and alternative billing routes.
2) Clinical coding & charge accuracy
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Expert coders who specialize in allergy & immunology (95004, 951xx series, E/M when applicable).
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Accurate unit entry (test counts, antigen units), correct modifiers, and linkage to ICD-10.
3) Clean claim submission & electronic follow-up
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Rapid electronic claims with payer-specific templates.
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Daily claim monitoring, re-submission, and automated follow-up workflows.
4) Denial analysis & appeals
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Root-cause denial analytics (repeat deniers, code/payer clusters).
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Customized appeals with clinical documentation and audit trails.
5) Patient billing & payment plans
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Clear statements and empathetic collections that preserve patient relationships.
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Set up flexible payment plans for high out-of-pocket treatment cycles (e.g., buildup periods for immunotherapy).
6) A/R optimization & KPI dashboards
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Weekly dashboards: clean claim rate, A/R aging >30/60/90, denial rate, net collection rate.
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Monthly strategy calls to review trends and implement process changes.
7) Compliance & audit readiness
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Documentation checklists for vial mixing, concentration logs, informed consent, and allergy shot schedules.
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Periodic internal audits to reduce risk of payer recoupments.
Why Choose Sirius Solutions Global for Allergy & Immunology Billing?
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Specialized Expertise in allergy and immunology billing
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End-to-End RCM Services from coding to collections
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AI-Powered Solutions for maximum efficiency
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Compliance-Focused to protect your practice from audits and penalties
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We combine specialty clinical knowledge with modern RCM technology and human review.
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We provide transparent KPIs so your leadership can see weekly progress.
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Our coders are trained in the 950/951 family of CPTs and unit-based billing.
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We stay current on payer policy updates and clinical guidance to protect your revenue.
Why Allergy & Immunology billing is different
Allergy and immunology billing is not “medical billing lite.” Tests and therapies are procedural, dose-sensitive, and highly payer-dependent. Common stumbling blocks we fix daily:
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Unit & quantity billing — Many allergy tests (e.g., percutaneous tests) and immunotherapy services must be billed by unit (the number of test pricks, the number of vials, or antigen doses) improper unit entry is a leading cause of denials.
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Allergen extract & vial mixing documentation — Payers want to see serum lot numbers, concentration, and dose schedules for immunotherapy; incomplete documentation often triggers recoupments.
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CPT/ICD nuance — The 950xx and 951xx family of CPTs (plus E/M when applicable) require precise mapping and modifier use. Staying current on code guidance and payer bulletins preserves revenue.
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Medicare & commercial rules — Medicare and each commercial payer treat tests and immunotherapy differently. You need a partner who maintains payer rules and proactively flags services that require preauthorization.
Common Ophthalmology Billing Challenges & How We Solve Them
1. Incorrect Code Pairings & Laterality Errors
Problem: Eye procedures often require laterality (left/right) and specific modifiers; wrong combinations trigger denials.
How we solve it: Our coding team enforces laterality checks and automated validation rules before claim submission. We run weekly audits to catch systematic coding drift.
2. Imaging & Diagnostic Confusion (OCT, OCTA, Fundus Photography)
Problem: Payers have strict rules about what imaging qualifies for reimbursement and whether imaging can be billed separately. New codes and edit logic (e.g., OCTA code updates) add complexity.
How we solve it: We map each imaging procedure to payer rules and use claim-scrubbing logic that reflects current CPT guidance, so imaging claims pass edits or include the required supporting diagnosis.
3. E/M Coding After Guideline Changes
Problem: Changes in documentation and E/M guidelines caused miscoding at some practices.
How we solve it: We train your clinical staff on documentation best practices for E/M services and use templates that align with current guidelines to support billed levels.
4. Prior Authorization & Medical Necessity Roadblocks
Problem: Surgeries and advanced imaging sometimes require prior auth; missing those leads to denials.
How we solve it: We check prior auth requirements at scheduling, secure authorizations, and store approvals in the patient chart to prove necessity during appeals.
5. Mixed Retail/Medical Revenue Streams
Problem: Practices must separate retail (glasses/contacts) from medical services; misallocated charges cause accounting confusion and payment disputes.
How we solve it: We implement clear charge capture flows and statements that separate retail receipts from medical claims, improving patient clarity and accounting.
6. Denial Recurrence & Process Gaps
Problem: Same denial repeats because root causes (documentation patterns, payer rules) are not addressed.
How we solve it: We present denial trend analytics, recommended process changes, and staff training which reduces recurrence over time.
Our approach people + processes + technology
Specialized human coders: certified coders with allergy/immunology training.
AI-augmented workflows: auto-flag likely denials and surface documentation gaps before claims go out.
Transparent portal & dashboards: weekly KPI emails and monthly review calls.
Custom onboarding: initial audit, backlog clean-up, and a tailored success plan focused on measurable KPIs (A/R reduction, clean claim rate improvement).
Typical outcomes we deliver
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Clean claim rate increases (example: 65% → 90%+ within 60–90 days with active remediation).
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A/R days reduction (often 25–50% improvement depending on starting point).
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Denial rate reduction and faster days-to-pay. Results vary by practice and payer mix
AI-Powered Allergy & Immunology Billing
At Sirius Solutions Global, we improve accuracy and efficiency using AI-driven billing tools:
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Automated Coding Recommendations: AI identifies the correct ICD-10/CPT codes for allergy testing, injections, and immunotherapy.
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Denial Prediction Models: Before submission, machine learning flags claims with a high probability of rejection using Denial Prediction Models.
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Revenue Forecasting: Artificial intelligence helps clinics forecast future reimbursements by examining payer trends.
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Smart Prior Authorization Tracking: It helps to more effectively handle payer contacts and so shorten biologic medication delays.
Higher income recovery, fewer errors, and quicker repayments are guaranteed by this.
How Our Expertise Benefits Allergy & Immunology Practices
Partnering with Sirius Solutions Global offers your practice:
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Increased Reimbursements: Correct billing guarantees you get compensated for every exam, injection, and treatment; it also helps to boost your reimbursements.
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Faster Payments: Accelerated cash flow and reduced delays result from clean claims.
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Reduced Denials: Systematic denial avoidance increases practice effectiveness by lowering denials.
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More Focus on Patients: Help your personnel concentrate on patient care by freeing them from billing responsibilities.
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Scalability: We fit your demands whether you are a single allergist or a large multispecialty practice.
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