Claims management
Medical Claims Processing and Management
Claims are validated before they go out, submitted electronically, and tracked until the payer acknowledges and processes them. If something goes wrong, we see it early, well before the filing deadline.
Claim scrubbing checks
- Patient and subscriber details
- Provider NPI and taxonomy
- Diagnosis-to-procedure linkage
- Modifiers and NCCI edits
- Payer-specific rules
- Timely filing windows
The problem
Where claims break down
Many payment delays start with a claim that should never have been sent in its original form.
How we handle it
How we manage claims
Every claim is checked, submitted and followed until the payer confirms receipt and processes it.
- Pre-submission scrubbing against payer edits
- Electronic professional and institutional claims (837P / 837I)
- Clearinghouse acknowledgment monitoring
- Rejection correction and resubmission
- Claim status checks for unacknowledged claims
- Secondary claim filing after primary payment
- Corrected and replacement claims when needed
- Timely filing tracking by payer
Rejections vs. denials
Two different problems, two different fixes
Process
From encounter to accepted claim
Build
The claim is created from coded charges and registration data.
Scrub
Automated and manual checks catch errors before submission.
Submit
The claim goes out electronically through the clearinghouse.
Confirm
Acknowledgments are monitored; rejections are fixed and resent.
Why it matters
What clean claims do for you
FAQ
Medical Claims Processing and Management: common questions
What is claim scrubbing?
Claim scrubbing is a set of checks run before a claim goes out. It catches missing or invalid data, code conflicts, missing modifiers and violations of payer-specific rules. That improves the chance the claim is accepted on the first try.
What is a clean claim?
A clean claim is one that is accepted and processed without needing corrections or additional information. The clean claim rate is the share of claims that meet that standard on first submission.
What happens when a claim is rejected?
A rejected claim did not enter the payer’s processing system. We correct the error identified in the rejection report and resubmit the claim, keeping an eye on the payer’s filing deadline.
Related services
Services that work alongside claims management
Let’s take a closer look at your revenue cycle
Tell us what’s getting stuck. Denials, old A/R, credentialing, reports nobody reads? We’ll look at how you work now and tell you straight what we’d change, and why.