Telehealth billing services for multi-state digital health providers
Actigy BPO links virtual-care billing checks, claims and follow-up to the provider's approved payer and state instructions.
Actigy BPO provides telehealth billing services for digital health providers using their existing systems. Nearshore business process outsourcing (BPO) teams in Bulgaria, Romania, Poland and Ukraine check supplied billing data, prepare claims and manage unpaid-claim follow-up. Providers retain clinical, coding and payer-contract decisions. A process audit and paid pilot test the agreed workflow before expansion.
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Key takeaways
Actigy BPO supports virtual-care billing through a defined queue, shared records and named client decision owners.
- Every Actigy BPO engagement starts with a process audit and a paid pilot.
- Actigy BPO delivers from teams in Bulgaria, Romania, Poland and Ukraine.
- Payer, state and date-of-service requirements come from client-approved instructions.
- Licensure and credentialing questions return to the provider.
- Case-study results describe one engagement, not a promised result for another provider.
Telehealth billing at a glance
Actigy BPO defines which virtual-care records, payers and billing stages enter the service. The written scope names retained provider tasks.
| Field | Actigy BPO service |
|---|---|
| Buyer | Digital health providers and their medical billing teams. |
| Work | Eligibility, billing-data checks, claims, denials, accounts receivable (AR) follow-up and posting. |
| Systems | The client's approved billing and clinical-record tools. |
| Delivery and hours | Bulgaria, Romania, Poland and Ukraine; agreed shifts for US payer calls. |
| Pricing | Per full-time equivalent (FTE) by role; written quote after the process audit. |
| Start | A paid pilot with defined checks, approval owners and reporting. |
Telehealth billing services across the revenue cycle
Actigy BPO connects the agreed stages of revenue cycle management (RCM). Operators use the source record, payer reply and client-approved rule for the claim's date of service. If clinical facts or provider credentials are missing, the record goes to its named owner. The team does not submit it without review.
| Stage | Actigy BPO work | Provider decision |
|---|---|---|
| Before the visit | Record eligibility responses and unresolved information. | Approve patient and treatment decisions. |
| Billing-data review | Check required fields and supplied status data. | Resolve coding, licensure and credentialing questions. |
| Claim preparation | Prepare claims under approved payer instructions. | Retain policy and submission authority. |
| Denial response | Record the reason and prepare the permitted next action. | Approve actions outside the written procedure. |
| Unpaid claims | Check status and record next actions for assigned AR. | Decide adjustments, refunds and write-offs. |
| Payment posting | Record remittance details and identify unmatched items. | Retain financial approvals and payment authority. |
Use insurance verification services for a defined pre-claim queue. Medical coding outsourcing covers an agreed coding-support scope under provider policy. The team does not infer a missing clinical fact to complete a claim.
How does telehealth billing for multi-state providers work?
Actigy BPO uses a client-approved rules table for each payer, state and date of service. The provider supplies current care records and credential status. Operators record gaps and send conflicts to the named owner. One national checklist cannot replace the client's review of its different payer terms and state rules.
| Record field | What the check preserves |
|---|---|
| Payer, plan and date | The rule version the client approved for the claim. |
| State and service setting | Supplied context and any unresolved mismatch. |
| Place of service and modifiers | Required client-approved values, with unclear items escalated. |
| Provider status | Supplied licensure or credential-status data and the responsible reviewer. |
| Evidence and owner | Source reference, check date and next action for an exception. |
The HHS telehealth billing resources give separate guides for Medicare, Medicaid and private plans. Actigy BPO follows the agreed process for each payer. The guide is not a list of current billing codes or a rule for every claim.
How Actigy BPO starts telehealth billing
Actigy BPO starts with the provider's current data and billing handoffs. The standard operating procedure (SOP) sets checks for missing fields, allowed actions and the client review route. A paid pilot tests those steps on a defined queue before the team takes on more work.
- Review the current flow. Trace records from the visit through claims, payer responses and recorded balances.
- Map the requirements. Identify the client-approved source for each payer and state queue.
- Name the owners. Assign clinical, coding, credentialing and financial questions to provider reviewers.
- Prepare the team. Train operators in the client's systems and test role-based access.
- Run the paid pilot. Record actions, returned items and missing inputs against the agreed baseline.
- Review the output. Use maker-checker quality assurance (QA) and sampled checks with a correction log.
- Expand approved delivery. Increase scope only after the agreed pilot checks are met.
Billing measures and risk controls
Actigy BPO defines each key performance indicator (KPI) with the client before reporting results. A clean claim rate must state which claims it counts. Days sales outstanding (DSO) must use the same method each time. Reports also track missing inputs, denial causes, unpaid claims and open posting items.
Actigy BPO separates a missing source record from an operator error. An old instruction goes to the process owner. Before sending a claim again, the team checks its history. Care, licence or credential questions stay with the provider, even when those questions delay billing work.
Use denial management services for the denied-claim workstream and AR follow-up services for unpaid claims. A rejection before adjudication is different from a denial after payer review. Their causes and follow-up routes remain separate.
Telehealth evidence from Actigy BPO
Actigy BPO reported a 97.8% clean claim rate and 31% lower DSO for one multi-site digital health provider. Read the telehealth RCM case study. Actigy BPO-reported, anonymized, not independently audited. Results depend on scope.
The case shows a joined billing workflow. It does not show that every payer or state gives the same result. A new provider needs its own baseline. The pilot records source quality, completed work and results before the client agrees more scope.
Decisions and patient data you retain
Actigy BPO prepares claims and appeals; the provider keeps clinical, coding and payer-contract decisions. Operators do not determine medical necessity, approve treatment or establish provider licensure. The client approves refunds, adjustments and write-offs. The team does not release payments.
Actigy BPO works on protected health information (PHI) only in the systems the client approves. Data handling for US healthcare clients, including HIPAA requirements, is agreed in the written scope and data processing terms. Access permissions, logs and QA records support the agreed controls.
The client checks payer and public-program limits before offshore access starts. Work that is not allowed stays outside the scope. The written scope and data-processing terms name locations, roles and approved subprocessors.
Coverage, price and delivery options
Actigy BPO teams in Central and Eastern Europe cover the full UK business day and the US morning. Calls to US payers require US-business-hour coverage in the written scope. Later shifts need agreement. Ukraine is outside the EU; the other listed hubs are in Bulgaria, Romania and Poland.
Actigy BPO prices most services per full-time equivalent (FTE) by role and sends a written quote after the process audit. Compare the quote with retained provider review, systems and transition costs. A managed service is an operating scope, not a replacement billing platform.
| Responsibility | Actigy BPO managed team | In-house team | Freelancer or staffing agency |
|---|---|---|---|
| Daily workflow | Managed within agreed procedures. | Provider manages the workflow. | Confirm who supervises the work. |
| Quality | Documented review and QA sampling. | Provider designs the checks. | Included review depends on the contract. |
| Decisions | Provider retains clinical and financial authority. | Provider retains authority. | Provider retains authority. |
| Tools | Client-approved systems and records. | Provider-selected systems. | Agree access and handover rules. |
When Actigy BPO fits virtual-care billing
Actigy BPO fits when a digital health provider needs joined billing queues and clear handoffs to reviewers.
Actigy BPO is not the right fit when the buyer needs clinical judgment, software alone or access that its payer terms prohibit.
How do you compare telehealth billing companies?
Actigy BPO offers a client-system workflow backed by a published telehealth case, with its limits stated. Compare payer-rule ownership, exception handling and the handoff between claims, denials and posting. Ask each candidate to explain which provider decisions stay outside the service. Evidence from one project is not a forecast for another.
When should providers outsource telehealth billing?
Actigy BPO fits providers with repeat work, agreed billing rules and staff who can resolve care or policy questions. First, find the cause of the backlog: missing records, too little capacity or a delayed decision. Outsourcing can add a defined team. It cannot replace provider approval or resolve a licence issue by sending more claims.
Telehealth billing questions
Actigy BPO answers these questions for providers selecting an operating partner, not for determining patient coverage.
What do telehealth billing services include?
Telehealth billing services coordinate administrative work around virtual-care claims and payer responses. Actigy BPO provides an agreed scope covering eligibility, billing-data checks, claim preparation, denials, AR follow-up and payment posting. Operators use client-approved systems and instructions. The provider retains clinical, coding and payer-contract decisions. The process audit identifies the exact workstreams and retained tasks; the service does not automatically include every function across the provider's revenue cycle.
Why are telehealth claims denied?
Actigy BPO reviews the payer's stated reason before preparing a response to a telehealth denial. Missing information, inconsistent billing data or a mismatch with the applicable requirements can need different actions. Operators follow client-approved instructions and escalate clinical, coding or provider-status questions. A rejection before adjudication is recorded separately. Current payer and state requirements belong in the approved process, not a universal code or modifier example copied from this page.
How does Actigy BPO support multi-state telehealth billing?
Actigy BPO uses a requirements matrix supplied and approved by the provider for each relevant payer and state queue. The record identifies the date of service, source instructions and unresolved fields. Operators check supplied licensure and credential-status data for the required administrative fields, then escalate gaps. The provider decides whether its requirements are met. The team does not determine licensure, approve clinical care or treat one state's instructions as universal.
Can telehealth billing be outsourced outside the US?
Actigy BPO can perform approved telehealth billing work from the agreed delivery locations when the client's contracts and data-access rules allow it. The client checks payer and government-program restrictions before the pilot. Calls to US payers require an agreed US-business-hour shift. Clinical and financial decisions remain with the provider. Offshore delivery does not establish patient-data access permission or remove a restriction stated in a payer agreement.
How are telehealth billing services priced?
Actigy BPO quotes telehealth billing services per FTE by role after the process audit. The quote depends on the workstreams, volume, payer mix, review needs, client tools and agreed coverage. Include retained provider review and transition costs when comparing options. A paid pilot tests the proposed workflow before expansion. The published telehealth case illustrates one engagement and does not establish a promised clean claim rate, recovery result or saving for another provider.
Related revenue-cycle services
Actigy BPO connects virtual-care work with medical billing outsourcing, payment posting and revenue cycle management outsourcing. Use the broader RCM page to map responsibilities across stages rather than creating overlapping queues.
Plan a virtual-care billing pilot
Actigy BPO needs business details about your payer groups, states, client systems, approximate volume and required hours. The form below is not for patient or clinical records. Protected information enters approved systems only after the access and processing terms are agreed.
Page updates
Actigy BPO published this service guide on October 4, 2026, with scope, controls and buyer questions.
Scope a pilot
What happens next
The team reviews the workflow before proposing a written scope. You decide whether to start a paid pilot after reviewing it.