Claims Submission Services
Clean claims get paid faster. MedPrecision's claims submission services combine rigorous pre-submission scrubbing with electronic delivery to achieve first-pass acceptance rates above 97%.
A rejected or denied claim costs your practice $25-$50 in rework expenses and delays payment by weeks or months. MedPrecision's claims submission services prevent these costly errors through multi-layered claim scrubbing that catches issues before they leave your office. Every claim is validated against payer-specific rules, NCCI edits, and LCD/NCD policies before electronic submission.
Who This Service Is For
The State of Claims Submission Services in 2026
The AMA's 2024 National Health Insurer Report Card found that the average first-pass claim acceptance rate across commercial payers is 89.3%, meaning over 10% of claims require rework before payment. MGMA data shows that each rejected claim costs a practice between $25 and $50 in administrative rework expenses, and practices with clean claim rates below 90% spend an estimated 3.1% of net revenue on claim rework alone. HFMA's 2024 Claims Management survey found that practices using multi-layer scrubbing achieve first-pass rates above 96%, compared to 87% for practices relying solely on clearinghouse edits. CMS processes approximately 1.2 billion Medicare fee-for-service claims annually, with an initial denial rate of approximately 17% according to KFF analysis, underscoring the importance of pre-submission validation. The transition to electronic claim submission has reduced processing time from 30-45 days for paper claims to 14-21 days for electronic submissions, but the financial impact of rejections remains significant. According to the CAQH Index, the healthcare industry could save $9.4 billion annually by increasing electronic claims submission and reducing manual intervention in the claims process.
What Is Breaking Right Now
Low first-pass claim acceptance rates causing delays and rework costs
Recurring claim rejections from the same payer-specific issues
Claims lost to timely filing deadlines due to poor tracking
Revenue delays from slow or manual claim submission processes
Common Claims Submission Services Mistakes to Avoid
Relying solely on clearinghouse edits for claim validation
Clearinghouse edits catch only basic formatting errors and standard code edits. They do not validate against payer-specific rules, contract provisions, or LCD/NCD policies, allowing a significant percentage of claims to pass through and be denied at the payer level.
Layer payer-specific edit rules on top of clearinghouse validation, including medical necessity checks, modifier requirements, and bundling rules unique to each payer.
Not tracking rejection patterns by payer and reason code
Without systematic tracking, the same rejection reasons recur indefinitely. Staff spends time fixing the same types of errors repeatedly rather than implementing preventive measures.
Maintain a rejection analytics dashboard that tracks rejection rates by payer, reason code, CPT code, and provider. Review weekly and implement corrective actions for any rejection category exceeding 1% of submissions.
Delaying secondary claim submission after primary adjudication
Secondary claims that are not submitted promptly after primary payment risk timely filing denials from the secondary payer. Many practices lose 5-10% of secondary payer revenue to this delay.
Automate secondary claim generation triggered by primary payment posting, with submission within 24 hours of primary EOB receipt.
Submitting claims without verifying prior authorization status
Claims for services requiring prior authorization that are submitted without a valid auth number are denied immediately. The appeal process is lengthy and success rates for retroactive authorization are low.
Build authorization verification into the pre-submission scrubbing process. Any claim for a service type that typically requires authorization is held until auth status is confirmed.
Using a single clearinghouse for all payers without performance analysis
Clearinghouse acceptance rates and processing speeds vary significantly by payer. Using a single clearinghouse can result in slower processing and higher rejection rates for certain payers.
Analyze clearinghouse performance data by payer quarterly and route claims through the optimal clearinghouse connection for each payer.
What We Handle
Multi-Layer Claim Scrubbing
Claims pass through automated edits, payer-specific rule checks, and manual review to catch errors that automated systems miss.
Electronic Claim Submission
ANSI 837 compliant electronic claims submitted to all major payers and clearinghouses with real-time acknowledgment tracking.
Rejection Management
Front-end rejections are corrected and resubmitted within 24 hours with root cause tracking to prevent recurring issues.
Timely Filing Monitoring
Automated tracking of payer-specific filing deadlines ensures no claim is lost to timely filing limits.
Multi-Payer Expertise
Submission rules for Medicare, Medicaid, Blue Cross, Aetna, Cigna, United, and hundreds of regional payers managed by our team.
Our Claims Submission Services Methodology
Payer Edit Rule Library Maintenance
We maintain a continuously updated library of submission rules for every payer your practice bills, including modifier requirements, bundling restrictions, medical necessity criteria, and documentation attachment rules. This library is the foundation of our scrubbing process and is updated within 48 hours of any payer policy change.
Multi-Layer Pre-Submission Scrubbing
Every claim passes through three validation layers before transmission: automated edit checks against NCCI, LCD/NCD, and MUE limits; payer-specific rule validation against our proprietary edit library; and manual review of flagged claims by experienced billing specialists. This layered approach catches errors that single-layer systems miss.
Clearinghouse Optimization
We analyze acceptance rates and processing speeds across multiple clearinghouses for each payer and route claims through the channel with the highest acceptance rate and fastest adjudication. Some payers process claims 5-10 days faster through specific clearinghouse connections, and we leverage those advantages.
Real-Time Rejection Triage
Rejections are captured in real time as clearinghouse acknowledgments are received. Each rejection is categorized by root cause, assigned to the appropriate resolution workflow, and corrected within the same business day. This prevents rejections from aging into timely filing risks.
Submission Analytics and Trend Monitoring
Weekly analysis of rejection rates by payer, rejection reason, CPT code, and provider identifies emerging patterns before they become systemic problems. A spike in rejections from a specific payer triggers an immediate rule library review and preemptive correction.
Secondary and Tertiary Claim Automation
After primary payer adjudication, secondary claims are automatically generated with the primary EOB data attached and submitted without manual intervention. This eliminates the common delay where secondary claims sit waiting for someone to process them manually.
Real Results
The Challenge
First-pass claim acceptance rate had dropped to 88% after a payer changed its modifier requirements for dermatologic procedures. The practice was resubmitting over 400 claims per month, creating a backlog that delayed payments by an average of 35 additional days.
Our Approach
MedPrecision conducted a payer-by-payer rejection analysis, identifying that 72% of rejections came from three payers with updated modifier and bundling rules. We reconfigured claim scrubbing rules for each payer, retrained the coding team on new modifier requirements, and implemented a pre-submission edit check specific to dermatology procedure bundles.
Key Outcomes
- check_circle First-pass acceptance rate improved from 88% to 98.2% within 45 days
- check_circle Monthly claim resubmissions dropped from 400+ to fewer than 50
- check_circle Average payment cycle shortened by 28 days
- check_circle Annual rework costs reduced by approximately $86,000
“The rejection volume was overwhelming our small billing team. MedPrecision not only fixed the immediate problem but built payer-specific rules so the same rejections could never happen again.”
Claims Submission Services: MedPrecision vs Alternatives
| Feature | MedPrecision | In-House | Other Providers |
|---|---|---|---|
| Pre-Submission Scrubbing | Three-layer validation: automated edits, payer-specific rules, and manual review | Basic clearinghouse edits only, no payer-specific validation | Automated scrubbing with limited payer-specific customization |
| Payer Rule Updates | Updated within 48 hours of any payer policy change | Updated reactively after rejections are received | Quarterly or semi-annual rule updates |
| Rejection Resolution Time | Same-day correction and resubmission for all front-end rejections | 3-7 day turnaround depending on staff workload | 24-48 hour standard turnaround |
| Clearinghouse Management | Optimal routing per payer based on acceptance rate and speed data | Single clearinghouse for all payers regardless of performance | Limited clearinghouse options with standard routing |
| Secondary Claim Processing | Automated generation and submission after primary adjudication | Manual process often delayed by weeks | Semi-automated with manual review required |
| Timely Filing Protection | Automated deadline tracking with escalation alerts at 30 days before expiration | Manual tracking with frequent missed deadlines | Basic deadline alerts without proactive management |
“A 97% clean claim rate sounds impressive until you realize that the remaining 3% represents thousands of dollars in rework costs and delayed payments every month. The goal is not just high acceptance rates but zero preventable rejections. Every rejection should trigger a rule update that prevents it from ever happening again.”
MedPrecision Billing Team
Director of Claims Operations
How the Transition Works
How we deliver claims submission services for your practice.
Claim Receipt & Initial Validation
Charges are received from coding, validated for completeness (demographics, insurance, codes, modifiers), and flagged if any required elements are missing.
Payer-Specific Scrubbing
Each claim is scrubbed against the specific payer's submission rules, including medical necessity checks, prior auth verification, and coding edit compliance.
Electronic Submission & Tracking
Clean claims are transmitted electronically via appropriate clearinghouses with real-time tracking of acceptance, rejection, and pending statuses.
Rejection Resolution & Feedback Loop
Rejected claims are corrected and resubmitted within 24 hours. Rejection patterns are analyzed and fed back to coding and registration teams to prevent recurrence.
What Reporting and Visibility Looks Like
Transparency is built into every engagement. You will always know where your revenue stands and what actions are being taken on your behalf.
Monthly KPI Dashboards
Track collection rates, denial trends, days in A/R, and payer-level performance with dashboards delivered on a fixed schedule.
Real-Time Claim Tracking
See claim status updates in real time so you never have to wonder where a payment stands or when follow-up is happening.
Quarterly Business Reviews
Detailed reviews with actionable recommendations covering denial root causes, payer trends, and revenue recovery opportunities.
Proactive Alerts
Automated alerts when key metrics shift, so issues are caught and addressed before they affect your bottom line.
Claims Submission Services Key Terms
- Clean Claim
- A claim that is accepted by the payer on first submission without requiring correction, resubmission, or additional information. A clean claim contains all required data elements, correct coding, and passes all payer-specific edits.
- ANSI 837
- The standard electronic format for submitting healthcare claims to payers, as mandated by HIPAA. The 837P is used for professional claims and the 837I for institutional claims.
- Clearinghouse
- An intermediary organization that receives electronic claims from providers, validates formatting, and routes them to the appropriate payers. Major clearinghouses include Availity, Change Healthcare, and Waystar.
- Front-End Rejection
- A claim that is rejected by the clearinghouse or payer before entering the adjudication process due to formatting errors, missing data, or basic edit failures. Unlike denials, rejections are not adjudicated decisions and do not count against timely filing.
- MUE Limit
- Medically Unlikely Edit. CMS-established maximum number of units of service that would be expected for a single CPT code on a single date of service for a single patient. Claims exceeding MUE limits are automatically denied.
- ERA (Electronic Remittance Advice)
- The electronic equivalent of an Explanation of Benefits, transmitted in ANSI 835 format. Contains detailed payment, adjustment, and denial information for each claim line, enabling automated payment posting.
- Coordination of Benefits
- The process of determining which insurance plan pays first (primary) and which pays second (secondary) when a patient has multiple insurance coverages. Incorrect COB information is a leading cause of claim rejections.
Common Questions
Common questions about claims submission services.
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Get a Free Billing Audit arrow_forwardWhat is a clean claim rate and why does it matter?
Your clean claim rate is the percentage of claims that pass through payer edits on first submission without rejection. Industry benchmark is 95%+, and MedPrecision clients typically achieve 97-99%. Every percentage point improvement means faster payments, less rework, and lower cost to collect.
How quickly are claims submitted after charges are entered?
Claims are scrubbed and submitted the same business day charges are entered. For charges received before 3 PM, claims are typically transmitted to payers by end of business the same day.
Which clearinghouses do you work with?
We submit through all major clearinghouses including Availity, Change Healthcare, Trizetto, Office Ally, and Waystar. We select the optimal clearinghouse for each payer based on acceptance rates and processing speed, and we manage all clearinghouse relationships on your behalf.
How do you handle secondary and tertiary claim submissions?
After primary payer adjudication, we automatically generate and submit secondary claims with the primary EOB attached. The same process applies to tertiary payers. We track coordination of benefits across all payers to ensure the patient's full coverage is utilized.
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