Fast Claim Submission
Whenever all charges related to a particular case are posted into the system, you can rest easy and let our team handle the submission of the client’s electronic claims (including HCFA 1500 claims) to the respective payers. We can work on all the clearinghouse denials and give proper feedback with suggestions to reduce the number of claims that do not pass the clearinghouse. We also send detailed reports to you on a daily, weekly, monthly, and yearly basis. We understand that your revenue stream needs to be steady, so we exercise due diligence in patient registration processes, minimizing the chance that claims will be denied and ensuring complete documentation for appealing denied claims. With Simplifyd Care as your partner, you can ensure all payments are collected in a timely manner and reduce your claims denials in order to improve your organization’s cash flow.
Once the charges are entered and audited, the claims are then filed with the payer electronically. We also have the capability to process paper claims. Usually at clearinghouses, the claims go through some type of cursory filtering software to ensure that they are accurate and all information is contained within the document. Within 24 hours, a paper report is sent back with errors that have been caught. Once we have the report, the incorrect claims are rectified with the necessary information within 24 hours and the claims are resubmitted to the insurance company. Claims are submitted electronically via the practice management system. However, we can process paper claims also. At this stage, a thorough quality check is done by a senior billing specialist and then submitted. The rejection report received from the clearing house, if any, is analyzed and the necessary changes are done. These claims are then resubmitted.
What is Included in a Medical Claim?
A general medical claim contains all the information a payer needs to know in order to reimburse a care provider for the covered services. The three most important aspects of any medical claim include:
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Basic patient information, including full name, birthday, and address
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The provider’s NPI (National Provider Identifier)
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CPT codes that reflect the provided services
The claim also contains information about provider charges and other pertinent information. Lastly, the claim detail section offers information regarding secondary diagnoses and National Drug Codes (NDCs).
What Happens After a Claim Submission?
Today, most claims are submitted electronically. However, in rare circumstances, claims are submitted in paper form too. Once the claim is submitted, it goes through an adjudication process in which the payer determines whether the claim is accepted, rejected, or denied
Accepted claims are paid to the provider, even though reimbursement is not always 100 percent of what the provider charges. Rejected claims—usually due to some type of error—are returned to the provider for correction with no payment.
Denied claims are also returned to the provider with no payment. Rejected and denied claims are common. For example, Medicare Advantage denies an average of 8 percent of claims, and some payers initially deny up to a third.