Streamlined Medical Billing for Doctors: Claim Submission Services

Ensure accurate and efficient medical billing for doctors with our expert claim creation and submission services. Our team specializes in reducing errors and denials, ensuring a seamless process from patient registration to reimbursement. By optimizing claim submissions, we help doctors focus on patient care while enhancing their financial outcomes. Contact us today to learn how our tailored solutions can benefit your practice.

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Key Steps in Claim Creation & Submission:

Patient Registration & Eligibility Verification

• Collect and verify patient demographics, insurance details, and coverage eligibility.

• Confirm pre-authorization requirements (if applicable).

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Medical Coding

• Assign appropriate CPT (Current Procedural Terminology) codes for procedures.

• Use ICD-10 (International Classification of Diseases) codes for diagnoses.

• Apply HCPCS (Healthcare Common Procedure Coding System) codes for supplies, drugs, and equipment.

Charge Entry

• Enter coded services into the billing system with correct modifiers (if needed).

• Ensure fees align with payer contracts and fee schedules.

Claim Generation

• Compile all data into a clean, error-free claim (CMS-1500 form for professionals / UB-04 for facilities).

• Perform internal audits to check for coding errors, missing information, or compliance issues.

Claim Submission

• Submit claims electronically (EDI) via clearinghouses (e.g., Change Healthcare, Availity) for faster processing.

• Alternatively, submit paper claims when required (though rare in modern billing).

• Track submissions with confirmation reports (TA1/277CA acknowledgments).

Claim Scrubbing & Error Resolution

• Use automated claim scrubbers to detect errors (missing codes, invalid modifiers, etc.).

• Correct and resubmit rejected claims promptly to avoid delays.

Payer Follow-Up & Denial Management

• Monitor claim status (via ERA/EOB or payer portals).

• Address denials or underpayments with appeals or corrected claims.

Best Practices for Efficient Claim Submission

✔ Accuracy First – Ensure correct coding and documentation to prevent denials.
✔ Timely Filing – Adhere to payer deadlines (typically 90–180 days from DOS).
✔ Electronic Submission – Faster processing and fewer errors than paper claims.
✔ Regular Audits – Identify and fix recurring issues in claim creation.
✔ Staff Training – Keep billing teams updated on coding changes (e.g., annual ICD/CPT updates).

Why Proper Claim Submission Matters

• Reduces Denials & Rejections – Clean claims have higher acceptance rates.

• Improves Cash Flow – Faster submissions lead to quicker reimbursements.

• Ensures Compliance – Avoids penalties for incorrect billing practices.

By optimizing claim creation and submission, medical billing companies help healthcare providers maintain financial stability and focus on patient care.