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Medical Coding Services
in Allentown, PE
Qualigenix codes each Allentown encounter to the chart, to Novitas Medicare policy and to the HealthChoices or commercial plan that pays it. Certified coders, HIPAA-compliant.
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How Qualigenix Serves Allentown Practices
Qualigenix medical coding services give Allentown practices coders who read the note before they pick a code. Lehigh County practices answer to several rulebooks at once: Novitas local coverage determinations for Medicare, five HealthChoices plans with their own payment and authorization policies, Magellan for behavioral health and commercial plans such as Capital Blue Cross. Coders are assigned by specialty and learn which policies drive your denials. Statewide coding and audit rules are on our medical coding services in Pennsylvania page. This page covers the plans an Allentown practice codes for.
What Medical Coding Services Does Qualigenix Provide in Allentown?
Qualigenix gives Allentown practices certified coders who review documentation, assign ICD-10-CM/PCS, CPT and HCPCS Level II codes, apply modifiers, check medical necessity, send physician queries and run two levels of QA. Coders follow Novitas Solutions coverage policy for Medicare and each plan's published rules for Medical Assistance and commercial claims.
Work happens inside your EHR, priced as a percentage of collections.
Medical Coding for Lehigh County's HealthChoices Plans
DHS lists five physical health plans for the Lehigh/Capital zone, which includes Lehigh County: AmeriHealth Caritas Pennsylvania, Geisinger Health Plan, Jefferson Health Plans EverWell, Highmark Wholecare and UPMC for You. The same code can pay at one plan and deny at the next.
Plan Policy Checks
Pennsylvania requires insurers and the Medical Assistance program to publish which services need prior authorization and to give providers access to their medical policies. Qualigenix coders read the treating plan's policy for any service on those lists before assigning codes. When the note doesn't meet the plan's criteria, the coder queries the provider before the claim leaves. Behavioral health encounters for Lehigh County members are coded to Magellan Behavioral Health of Pennsylvania's requirements, since the county's behavioral program runs through Magellan.
Fee-For-Service Code Limits
Patients who stay in Medical Assistance fee-for-service fall under state program rules. DHS's billing FAQ says HCPCS J codes are not compensable under Medical Assistance, for example. Qualigenix coders check the fee schedule and program rules before a drug or supply line goes out on a fee-for-service claim.
Statewide Audit Rules
DHS runs prepayment and post-payment reviews and publishes a self-audit protocol for Medical Assistance providers. Qualigenix keeps Allentown charts ready for both. Statewide detail is on our Pennsylvania medical coding rules page.
Medicare and Commercial Payers for Allentown Practices
Novitas Solutions is Pennsylvania's Jurisdiction L Medicare contractor. Its local coverage determinations decide which diagnoses support which procedures for Allentown Medicare patients, so Qualigenix coders check the LCD and any billing article before pairing codes. Dual-eligible patients in a special needs plan, such as Highmark Wholecare Medicare Assured Diamond, are coded to that plan's policy first. Capital Blue Cross, which serves the Lehigh Valley and central Pennsylvania, publishes its own reimbursement and medical policies for its commercial and Medicare Advantage networks. Qualigenix codes to whichever plan the patient carries, across all payers your practice bills.
PROVEN CODING OUTCOMES
Results Allentown Practices Can Expect
These are company-wide results across Qualigenix client practices, not Allentown-only figures. Every Allentown account runs on the same coding and QA process.
98.9%
Coding accuracy
98.9%
Post-audit coding accuracy
98.6%
Compliance and audit pass rate
Reduced to 2%
Coding-related denials
300,000+
Charts audited per quarter
Under 1%
Compliance risk
2M+
Charts coded to date
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ Clinics6-DAY ONBOARDING
How Onboarding Works
Qualigenix establishes full medical coding operations for Allentown practices in six steps, averaging six days from kickoff to live export.
01
Kickoff and Scope
We sign the BAA and SLA, name a coding lead and set scope by encounter type and code set.
02
Coders and Intake
Specialty-certified coders are matched to your mix, and charts come in securely from your EHR with a completeness check.
03
Playbook and Benchmarks
We write a coding playbook for your specialties and top Lehigh County payers, with accuracy and turnaround targets agreed up front.
04
Documentation and Queries
Coders review each record before coding and send compliant queries wherever documentation falls short.
05
Coding and QA
Codes and modifiers are assigned, medical necessity is checked against LCD and NCD policy, and two QA levels follow.
06
Go Live, Improve
Coded encounters export daily to your billing system, and denial root causes feed back into coder training.
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WHY ALLENTOWN PRACTICES CHOOSE QUALIGENIX
Why Allentown Practices Choose Qualigenix
CPC and CCS certified coders, seamless EHR integration, two-level QA review, and rapid six-day onboarding.
CPC and CCS Certified
Allentown charts are coded by CPC and CCS certified coders assigned to your specialty. The same coders stay on your account and learn your providers' documentation habits.
Works in Your EHR
Coders work inside your system across 133 EMR and EHR platforms. Charts stay put, and providers answer queries in the tools they already use.
Two QA Levels
Every chart passes a peer or auditor review and then statistical sampling. You see accuracy by coder and specialty, not one blended number.
Six-Day Average Onboarding
Most practices go live in 6 days on average, so a coding backlog doesn't build while you change vendors or replace an in-house coder.
ALLENTOWN CODING FAQS
Frequently Asked Questions
Frequently asked questions regarding Lehigh/Capital zone HealthChoices policies, Magellan Behavioral Health, Novitas Medicare LCD matching, and certified coding in Allentown.
Allentown practices can use local coders or national coding companies that know Pennsylvania payers. Qualigenix codes for all payers, including Novitas Medicare, Medical Assistance, the five Lehigh/Capital HealthChoices plans and Capital Blue Cross. Ask any vendor how it checks plan policy before coding.
Yes. Qualigenix codes Medical Assistance fee-for-service and HealthChoices claims. Coders check the fee schedule, program rules and the treating plan's published policy before a claim goes out.
Coders check the Novitas local coverage determination and its billing article for each covered service, then pair the diagnosis and procedure codes the policy supports. When a note falls short, they query the provider first.
Yes. Qualigenix coders hold CPC and CCS certifications and are assigned by specialty. Every chart also goes through two levels of QA.
Yes. Qualigenix runs prospective and retrospective coding audits, including HCC review, so Allentown charts are ready for a Medicare or Medical Assistance review. Findings feed into coder training.
Qualigenix charges a percentage of collections. The percentage depends on specialty, encounter types and volume. A coding specialist can walk through it for your practice on a call.
No. An Allentown practice needs coders who know Novitas policy, the Lehigh/Capital HealthChoices plans and its own specialty. Qualigenix assigns specialty coders who work inside your EHR.