Medical claims submission services
Medical claims submission is turning a visit’s charges into a clean claim, sending it to the payer, and following it until the payer has made a decision.
A claim’s journey
Five stopsFollow a claim from the visit to the payer’s decision.
Stop 2 of 5 · Scrub
Each claim is checked against payer and coding edits before it leaves: codes, modifiers, place of service, and provider and patient details.
What holds it up: Missing or invalid data, the wrong place of service, or codes that fail the payer’s edits get the claim rejected.
What holds a claim up?
Charges that never become claims
A visit on the schedule with no charge entered, so it is never billed at all.
Errors the payer’s edits catch
Missing or invalid data, the wrong place of service, or codes that fail the payer’s edits, so the claim is rejected before it is processed.
The wrong form or the wrong payer
A professional claim sent where an institutional one was needed, or a claim sent to a plan that isn’t the patient’s primary.
Claims sent late
A claim that reaches the payer after its timely-filing limit can be denied however correct it is.
Claims nobody is watching
Submitted, then forgotten: no acknowledgment checked and no status followed, until the claim ages into A/R.
How the claims submission process works
Capture every charge
We match the charges against your appointment schedule, so a visit without a charge is caught before it goes unbilled.
Enter charges and patient details
Charges, demographics and insurance details are entered into your practice management system as the visit was documented.
Scrub the claim
Each claim is checked against payer and coding edits before it leaves: codes, modifiers, place of service, and provider and patient details.
Submit it the way the payer takes it
Electronically through the clearinghouse wherever the payer accepts it, and on a CMS-1500 or UB-04 where it doesn’t.
Fix rejections and track it to a decision
Clearinghouse and payer rejections are corrected and sent again, and every claim is followed until the payer pays or denies it.
Free tool
What are denials costing your practice?
A few numbers you already know. See the rework cost and what never comes back, with every assumption shown.
Open the calculator- Claims a month
- 1,000
- Denial rate
- 7.5%
- Average paid
- $120
Related billing services
- Medical codingCPT, ICD-10 and HCPCS codes matched to the documentation and the payer’s rules.
- Eligibility verificationCoverage and benefits checked before the visit, so claims do not fail on eligibility.
- Denial managementEvery denial traced to its cause, corrected or appealed, and stopped from repeating.
- A/R follow-upUnpaid claims worked by age and value until they are paid or closed.
Related specialties
Claims submission questions
What is a clean claim?
What is the difference between a CMS-1500 and a UB-04?
How long do we have to submit a claim?
Is charge entry part of claims submission?
Find out how many of your claims go out clean.
Unsure how much revenue you are missing? Start with a complimentary billing audit.
Free consultation