Medical Claims Processing and Submission
Clean claims scrubbed, submitted electronically and tracked until they are paid.
Charge entry from your EHR or superbills
Eligibility check before submission
Claim scrubbing against payer edits and NCCI
How We Help
The fastest way to get paid is to get the claim right the first time. Every rejected or denied claim adds weeks to your payment and staff time to fix it. We prepare, scrub and submit your claims electronically, with a goal of submission within 24–48 hours of receiving complete charge information, then track every claim until the payer responds so nothing sits unnoticed in a clearinghouse queue.
Every client gets a dedicated billing team, clear monthly reporting and direct access to our specialists by phone and email.
What's included
- Charge entry from your EHR or superbills
- Eligibility check before submission
- Claim scrubbing against payer edits and NCCI
- Electronic submission (837P and 837I)
- Same-day handling of rejections
- Claim status tracking and follow-up
- Secondary and tertiary claim billing
Our claims process
- Charge capture: charges are entered from your EHR or superbills, and we confirm every billable service is captured.
- Eligibility check: coverage and plan details are confirmed so the claim goes to the right payer with the right member ID.
- Claim scrubbing: each claim is checked for missing data, invalid codes, modifier errors, NCCI edits and payer-specific rules before it leaves.
- Electronic submission: professional claims go out as 837P (CMS-1500) and facility claims as 837I (UB-04) through your clearinghouse.
- Rejection handling: clearinghouse and payer rejections are fixed and resent the same or next business day.
- Status tracking: we monitor claim status responses and follow up on any claim with no response within 30 days.
- Payment posting: when the 835 remittance arrives, it is posted and checked against the expected amount.
Rejections vs. denials
A rejection means the claim never got into the payer's system, usually because of a formatting or data error such as a wrong member ID or an invalid code. It can be fixed and resent quickly. A denial means the payer processed the claim and refused to pay it, which takes a corrected claim or a formal appeal. Good claims processing catches rejection problems before submission, and our denial management team handles the rest.
What we measure
| Metric | What it tells you | Common target |
|---|---|---|
| First-pass clean claim rate | Share of claims accepted on first submission | 95% or higher |
| Charge lag | Days from visit to claim submission | Under 3 days |
| Rejection rate | Claims rejected by the clearinghouse or payer | Under 5% |
| Days to payment | Time from submission to payment | Varies by payer |
You see each of these in your monthly report.
Payers and claim types
We submit to Medicare, Texas Medicaid and its managed care plans, and commercial payers including BCBS of Texas, UnitedHealthcare, Aetna, Cigna and Humana. We handle professional, facility, laboratory and ambulatory surgery claims, including secondary and tertiary claims after the primary payer pays.
Related: Medical billing · Eligibility verification · Coding services · Denial management · A/R follow-up
What clients see when billing runs well
01How quickly are claims submitted?
Our goal is to submit clean claims within 24–48 hours of receiving complete charge information.
02Do you handle secondary insurance?
Yes. Once the primary payer pays, we bill the secondary payer with the primary's remittance attached.
03What if we use our own clearinghouse?
That's fine. We can work inside your existing clearinghouse and practice management system.
04Do you submit paper claims?
Only when a payer requires it. Almost all claims go out electronically, which is faster and easier to track.
Keep the whole cycle moving
Eligibility Verification
We confirm coverage, benefits, copays and authorization needs before the visit, so claims aren't denied for preventable reasons.
Learn more →Compliance With Regulations
HIPAA-compliant processes, payer-rule monitoring and documentation checks that keep your practice audit-ready.
Learn more →Patient Billing & Invoicing
Clear patient statements, payment options and friendly follow-up that improve patient collections.
Learn more →Ready to Get Paid Faster?
Get a free billing review. We'll look at your current collections, denials and A/R and show you where revenue is being lost.