Welcome to NextLimit


NextLimit has spearheaded the province of insurance claims outsourcing process. We have been adjudicating medical claims to our clients, implementing the HIPAA complaint systems and captivating them with our resolution of 99 percent plus level of accuracy. Adhering to the CMS guidelines, we keep a stern focus on our project processing timeliness. We feel proud to convey the fact of our executive members being trained in several industry- claims adjudication software and can adapt to any claims- adjudication system within a short period.
  • Discerning member eligibility criteria
  • Verifying all imputed parameters in case of un-electronically filed claims
  • Primary insurance verification
  • Determination of timely filing limit of claims
  • Confirmation of provider status (participating / non-participating)
  • Checking authorization notes for instructions and applying authorization status to claims
  • Identification of duplicate / corrected / interim / final submissions
  • Determination of DRG
  • Apply case-rate / per diem to services within the purview of the case-rate / per diem contract
  • Determination of correct allowable
  • Ensuring that co-pay, coinsurance, deductible and OOP are accurate
  • Calculated and applied as per the benefit plan
  • Use of appropriate remark & adjustment codes
  • Real time audits
  • Customized reporting:-
  • Inventory report
  • Quality report
  • Production report
  • Pend report
  • Skip report


At NextLimit, we feel euphoric for prospering our clients with a complete range of credentialing services through a time-tested technique.

Did you know that proper credentialing requires a watchful eye for total and stringent compliance with applicable standards? It also requires the proper evaluation of applicants with respect to their competencies. For this, a number of resources are consulted such as the social, academic and professional history of the applicant, peer and expert reviews, end-user reviews on the quality of the applicant’s services, and more.

At NextLimit, we are fully equipped to take care of all these requirements quickly and efficiently. We approach the subject in an organized and systematic manner. The key steps in our credentialing process are as follows:

  • Full range of credentialing services
  • Re-credentialing after every 3 years
  • Regular update of provider’s data in credentialing and claims systems
  • Generation of all pertinent reports :-
  • HSD report
  • Physician and Facility reports
  • Weekly Add/Term report
  • Delegated credentialing report
  • Group/taxonomy etc.
  • Specific Ad-Hoc reports
  • At NextLimit, we work with a troupe of credentialing experts who strictly abide by the standards and guidelines entailed within the Medicare Managed Care Manual (MMCM) and National Committee for Quality Assurance (NCQA).


The Billing and Collection team at NextLimit provides the Medicare and Medicaid HMOs with customized and hospitable solutions, commercial Insurance plans as well as PBMs; enabling them to achieve sustainable results. Our certified public accountants and financial analysts manage each process, using our robust data warehouse and state-of-art technology. We are fully equipped and well-positioned to cater all our clients, providing them with sound, full-cycle billing and collection solutions. All of this in an astonishing cost-effective manner.

  • Data Preparation and Entry
  • Accounts Payable and Receivable
  • Premium Billing
  • Payment Tracking/Logging and Member Premium Reconciliation
  • Plan to Plan Reconciliation
  • Risk Management
  • Report Generation, including DOI (Department of Insurance) Reporting, Cash Flow Statement, and Segmental Report etc.
  • Risk Sharing and Yearly CMS Payment Reconciliation


At NextLimit we have a large team of experienced Customer Care personnel that we take pride in.

The team has persuaded decades of collective experience in the board and is filled by highly skilled Customer Care professionals adept at handling all issues and queries that arise in the line of business.

In addition to that, the team boasts of below one percent call abandonment rate. Thus, we successfully and seamlessly build brand equity with each customer touch point while transforming services into profitable sales.

Finally, most of the members in our Customer Care team are capable of handling a wide range of responsibilities besides performing their routine functionalities. In other words, they often work in telemarketing and sales while working hand-in-hand with our analysts, helping them take prudent decisions and are associated with survey projects on healthcare products.

With so many facilities under one roof, why would you look anywhere else?

  • Claims status/Prior authorization status inquiry and follow-up
  • Benefit coverage and member eligibility inquiry
  • Member acquisition and retention calls
  • Patient/provider outreach and education
  • Trained personnel with extensive domain experience (healthcare)
  • Voice-trained call executives with neutral US accent
  • Appeals and grievances handling
  • Billing, payment support and collections
  • Multilingual support
  • Real-time call barging
  • 100% call recordings
  • Daily call audit, and much more!


Prior authorization (also referred to as pre-certification or pre-authorization) has now become the cornerstone of the administrative functions with the Health insurance policies being on a constant metamorphosis. The in-house team being affected by its complexities, will impact negatively on your practice’s finance. During such cases, be rest assured on us.

NextLimit with its consultative aptitude and state of the art solutions in prior authorization will handle all operational hassles so that you can focus on your care management priorities. We are your one-stop address and the perfect mediators with the Payor, dedicated to help remove all your pre-cert process hurdles that might incapacitate your bottom line. We offer a 360 degree program in practice management with an exclusive skill-set that starts with a synchronized process of patient information collection to availing prior authorization for both inpatient and outpatient services.

We also seek to add value through our ideologies on verification services that remove unpleasant surprises from the path of claims submission and payment, thanks to our proven methodology which can eliminate errors quickly and address issues effectively.

“NextLimit provides you stand alone prior authorization assistance unlike any of our competitors. We believe in laying down the right checks and balances that improves your practice management efforts with our disciplined support.”

-Authority (team)

  • $7 per hour
  • Turnkey all-inclusive prior authorization services (Authorization Request + Follow-up + Approval)
  • 100% HIPAA compliant
  • Rx notification to the pharmacies (For prior authorization on medication)
  • Scheduling delivery of drugs with pharmacies
  • Competitive pricing, with no overtime and zero overhead
  • Helping you focus on patient-centric activities
  • Long standing alliances with leading health insurers
  • Flexible engagement model without lockup or binding service clause


Our medical coding and billing services are designed to address a wide range of issues and challenges faced by hospitals and physicians while dealing payments. Our billing process experts can provide customized solutions to help you achieve your business objectives. These solutions not only dramatically improve efficiency in a surprisingly cost-effective manner, but also allow you to focus on the more important aspects of your business.

A thorough understanding of the nuances associated with various physician specialties is required. All claims that have not been closed out in the system are categorized by age and insurance for effective management of the follow-up process. Billings of secondary claims are also followed up to reduce the patient’s financial responsibility while ensuring better collections.

  • Accurate coding combination, i.e. service code, diagnosis code, modifiers and place of service code
  • Error free patient’s detail entry
  • Real time transaction audits for patient and charge entry
  • Claims submission within 48 hours of receiving patient (demographic & insurance) and service information
  • Rejection follow-up within 24 hours
  • Tracking and follow-up of partial or incorrect payments
  • Denial management based on detailed analysis
  • Methodical and proactive AR follow-up
  • Timely payment posting to reflect accurate AR
  • HIPAA compliant
  • Customized reporting :
  • Claims submission
  • Collections
  • Denials
  • Accounts receivables


Durable Medical Equipment (DME) or Home Medical Equipment (HME) as they are sometimes called requires in-depth knowledge of reimbursement guidelines of Medicare, Medicaid and Commercial Plans, in case of their billing.

NextLimit has a highly capable team of DME billing experts who can make your workload easier. With NextLimit by your side, you can leave all your DME billing worries to expert care. Outsourcing your DME billing requirements to us will allow you and your staff to concentrate on marketing, growing and running your business operations, rather than focusing on bill management and collections department. Our diligent physicians and payor follow-up activities also help reduce turn-around time and improve cash flow.


  • Initial Visit Appointment Setup
  • Order Entry
  • Initial Eligibility Verification
  • Initial Evaluation Appointment
  • Detailed Eligibility Verification & Authorization Requirement Checking
  • Doctor’s Office Follow Up
  • Authorization/ Pre- Determination/ Referral Initiation
  • Final Eligibility Verification Or Pre-Delivery Check
  • Office Coordinator Notification
  • Schedule Delivery
  • Delivery
  • Claim submission
  • Rejection management
  • AR Follow-Up and Denial Management
  • Payment posting


Our Accounts Receivable follow-up process monitors and proactively pursues collection of payments. All claims that have not been closed out in the system are categorized by age and insurance for effective management of the follow-up process.

At NextLimit, every cash amount receives the same degree of attention as the other, irrespective of its size or source. Combine that with our high accuracy standards and you can rest assured that every penny you are entitled to will be claimed and recovered by us in the shortest possible time!

  • Streamlined and improved workflow using effective tracking tools
  • Multiple follow-up calls for the same claim
  • Follow-up on all paper submissions
  • Payor-specific analysis
  • Payor-specific analysis
  • Detailed reporting with suggestions for actions to be taken
  • Improved cash flow
  • Reduction in turn-around time
  • 100% HIPAA compliant


NextLimit also maintains strict adherence to the Fair Debt Collection Practices Act when contacting patients with the aim to collect unpaid dues from them. We understand the need to proactively communicate with patients with regards to collections. It is, therefore, imperative to understand the billing process thoroughly. We acknowledge the need to be respectful and patient while communicating with patient debtors.

  • Review patient’s account quickly and accurately on an incoming call prior to placing an outgoing call
  • Communicate with the patient explaining the need for the courtesy call
  • Take a payment on the account and or record a promise to pay in the notes
  • Go over patient’s account information with the authorized person if needed, once the account is verified properly
  • Identify the patient’s difficulties to pay on the account and to offer appropriate payment plans or Financial Aids based upon their situations and eligibility
  • Explain and justify the charges on a statement prior to billing them to the patient
  • Track and ensure effective follow up on all accounts for better turn-around
  • Handle billing disputes and to justify if a charge is required to be written off
  • Correspond with the attorney’s office appointed by the patient on behalf of the provider’s office
  • Maintain a healthy relationship with the patient and offer an excellent customer service experience above all, to make sure that the provider’s business experience is outstanding.