Claims Submission Services
Clean claims get paid faster. MedPrecision's claims submission services own one segment of the cycle and name it: the claim from the moment coded charges arrive to the moment the payer accepts it into adjudication -- three layers of pre-submission scrubbing, electronic transmission, and every front-end rejection worked the day the acknowledgment comes back.
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What Are Claims Submission Services?
Claims submission services prepare, scrub, and electronically transmit ANSI 837P (professional) and 837I (institutional) healthcare claims to payers via clearinghouse connections. The scope starts when coded charges arrive and ends when the payer accepts the claim into adjudication: pre-submission edits (NCCI, MUE, LCD/NCD), payer-specific rule validation, modifier and bundling checks, electronic transmission, front-end rejection triage, and secondary/tertiary claim generation. What happens after adjudication — a CARC-coded denial, an appeal, aged A/R — is denial management, not submission. Two metrics are routinely confused here and this page keeps them apart: a clean claim rate measures ACCEPTANCE into adjudication on first submission, while a denial rate measures claims that reached adjudication and were denied. Neither is the complement of the other. No professional society publishes a clean-claim-rate target; the nearest free physician-practice measurement of first-pass performance is MGMA's 8% single-specialty aggregate rate for claims denied on first submission in 2023, unchanged from 2019 — a denial measure, not a clean-claim rate.
- Clean-claim scrubbing against payer edits, reported as first-pass acceptance by payer
- Three-layer scrubbing: NCCI/MUE edits + payer-specific rules + manual review
- Same-day correction and resubmission of front-end rejections
- Automated secondary claim generation off primary 835 ERA
Pre-submission validation is the cheapest dollar in the revenue cycle, and the one publishable measurement says so plainly: MGMA reported a single-specialty aggregate rate of 8% for claims denied on first submission in its 2023 DataDive Practice Operations data set — the same rate it documented in 2019. Four years of clearinghouse tooling moved that number by nothing, because most first-pass failures originate before the claim reaches a scrubber. Worth stating plainly alongside it: the "95-98% clean claim benchmark" quoted across this industry has no traceable primary source, AAFP publishes no clean-claim-rate figure at all, and HFMA's MAP Keys define the metric without setting a target. This page also states where the work starts and stops, because the boundary is what decides who owns a problem: claims submission begins when coded charges arrive and ends when the payer accepts the claim into adjudication. Choosing the code the documentation supports is medical coding; keying the charge is charge entry; everything after adjudication — a CARC-coded denial, an appeal, aged A/R — belongs to denial management and A/R follow-up. MedPrecision's claims submission services run every claim through three layers before transmission: automated NCCI, LCD/NCD, and MUE edits; payer-specific rule validation against a continuously maintained library updated within 48 hours of any payer policy change; and manual review of flagged claims by certified billing specialists. Claims are submitted electronically via the optimal clearinghouse per payer (Availity, Change Healthcare, Trizetto, Waystar, Office Ally), with same-day rejection correction, automated secondary submission, and filing deadlines tracked from your own payer contracts rather than from a published industry range — Medicare's limit is set by regulation at the close of the period ending one calendar year after the date of service (42 CFR 424.44), while commercial windows come from your participation agreements and are typically much shorter.
Who This Service Is For
The State of Claims Submission Services in 2026
First-pass performance is the metric this service exists to move, and it is worth being precise about what is actually known about it. The one freely published physician-practice measurement is MGMA's: a single-specialty aggregate rate of 8% for claims denied on first submission in the 2023 DataDive Practice Operations data set, which MGMA notes matches the rate it documented in 2019. No professional society publishes a clean-claim-rate or first-pass acceptance target — HFMA's MAP Keys define revenue-cycle metrics without attaching values to them, and AAFP publishes no clean-claim figure while publishing targets for days in A/R, the adjusted collection rate and the denial rate. Note what that last one is measured on: AAFP computes its denial rate as denied dollars over submitted dollars, a different denominator again from either a claim-count denial rate or a clean claim rate, so the three cannot be lined up in one column. The widely circulated "98%" and "95-98%" clean-claim benchmarks trace to vendor-sponsored content rather than to society research, which is why this page quotes neither. What follows from the flat 2019-to-2023 line is operational rather than statistical: scrubbing tooling has improved substantially over that period without moving the aggregate, so the constraint sits in the daily rejection workflow — whether front-end rejections are worked the day they arrive — rather than in the edit library. Rejections that age quietly become timely-filing denials (CARC 29), which no appeal recovers.
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, whose filing clock is separate from the primary's and on many contracts runs from the primary remittance date rather than from the date of service.
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
Each payer's filing deadline is recorded from your own participation agreement at onboarding rather than from a general industry range, then tracked per claim with escalation before the window closes.
Multi-Payer Expertise
Submission rules for Medicare, Medicaid, Blue Cross, Aetna, Cigna, United, and hundreds of regional payers managed by our team.
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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 that performs best in your own data. Where a payer-clearinghouse pairing measurably outperforms, routing is changed; where the difference sits inside the noise, it is left alone. We publish no days-saved figure for clearinghouse routing, because no free source measures one.
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.
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 high clean claim rate sounds impressive until you look at what the remainder costs. Every rejected claim is worked twice, paid later, and spends the delay inside a filing window that is still running. The goal is high acceptance and 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 the payer accepts into adjudication on first submission, without requiring correction, resubmission, or additional information. The event being measured is acceptance, not payment: a clean claim can still be adjudicated and then denied, which is why the clean claim rate and the denial rate are separate measures on separate denominators.
- 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 returned by the clearinghouse or the payer before it enters adjudication, because of formatting errors, missing data, or basic edit failures. Unlike a denial, a rejection is not an adjudicated decision and carries no appeal rights. It also does not pause the timely-filing clock: a rejected claim was never accepted as filed, so the payer's window keeps running until a corrected claim is accepted.
- MUE Limit
- Medically Unlikely Edit. Per the CMS National Correct Coding Initiative Policy Manual (Chapter 1, revision date 1 January 2026), an MUE is the maximum units of service reported for a HCPCS/CPT code on the vast majority of appropriately reported claims by the same provider for the same beneficiary on the same date of service. What happens above that value depends on the code's MUE Adjudication Indicator: MAI 1 is a claim-line edit, MAI 2 an absolute date-of-service edit, and MAI 3 a date-of-service edit that can be reconsidered where the documentation supports the units. "Over the MUE, therefore denied" holds without qualification only for the absolute ones.
- 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 primary driver of claim rejections.
Common Questions
Common questions about claims submission services.
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Get a Free Billing AuditWhat is a clean claim rate and why does it matter?
Clean claim rate is the share of claims the payer accepts into adjudication on first submission, without correction, resubmission, or a request for additional information. The event being measured is acceptance, not payment. No professional society publishes a target value for it. HFMA's MAP Keys define revenue-cycle metrics without setting targets, AAFP publishes no clean-claim-rate figure at all — its practice-finance guidance covers days in A/R, the adjusted collection rate and the denial rate, and nothing else — and the widely relayed "98%" traces to a vendor-sponsored article rather than to any society benchmark. The nearest free physician-practice measurement of first-pass performance is MGMA's 8% single-specialty aggregate rate for claims denied on first submission in 2023, the same rate it documented in 2019. Read it for what it is: a denial rate on claims that reached adjudication, not a clean-claim rate, and not one minus a clean-claim rate. Why any of this matters is mechanical rather than statistical. A rejected claim re-enters the queue at the back and consumes staff time twice, and because a rejected claim was never accepted as filed, the payer's filing clock keeps running while it sits — which is how a rejection turns into a timely-filing denial (CARC 29) that no appeal recovers. Track your own rate as a trend against your own baseline; a vendor quoting an industry clean-claim benchmark is quoting something that does not exist.
How quickly are claims submitted after charges are entered?
Claims are scrubbed and submitted the same business day charges are received. For charges entered before the 3 PM cutoff, claims are transmitted to clearinghouses by end of business the same day; charges received after 3 PM go out the following morning. Same-day submission matters for two reasons. First, every day between the date of service and transmission is a day added to days in A/R and taken out of the filing window, because the filing clock runs from the date of service, not from the date the claim was built. Second, the window is set per payer and is often much shorter than practices assume: Medicare's limit is fixed by regulation at the close of the period ending one calendar year after the date of service (42 CFR 424.44), but commercial windows are not set by regulation at all — they come from your participation agreement — which is why we record each payer's deadline from your own contracts at onboarding rather than working from a published range. Each claim moves through four stages inside the same-day window: receipt and completeness validation (demographics, insurance, CPT, modifiers, ICD-10), payer-specific scrubbing against the maintained edit library, electronic transmission via the optimal clearinghouse, and clearinghouse acknowledgment capture for any front-end rejections. Rejections that come back within minutes of submission are corrected and resubmitted the same day.
Which clearinghouses do you work with?
MedPrecision submits through all major clearinghouses: Availity, Change Healthcare, Trizetto (Cognizant), Office Ally, Waystar, and direct payer portals where direct submission outperforms clearinghouse routing. The clearinghouse selection per payer is data-driven rather than fixed: acceptance rates, average adjudication time, and rejection-reason granularity vary by payer-clearinghouse pairing. We do not publish a days-saved figure for that difference — no free source measures one for physician practices, and the only honest version is the change we can show in your own acceptance and turnaround data. Claim routing is therefore reviewed quarterly per payer against that data rather than configured once and left alone. All clearinghouse relationships, enrollment paperwork, EFT/ERA setup, and credential maintenance are handled by MedPrecision; the practice does not manage individual clearinghouse contracts. Nearly all claims are submitted electronically, with the residual paper claims limited to specific Medicaid plans and workers' comp carriers that still require paper UB-04 or CMS-1500 submission.
How do you handle secondary and tertiary claim submissions?
Secondary and tertiary claims are generated automatically the moment the primary payer's 835 ERA is posted, with the primary EOB data attached in the required ANSI 837 coordination-of-benefits segments. This automation matters because the secondary payer's filing clock is a separate clock from the primary's, and on many contracts it runs from the primary remittance date rather than from the original date of service — a distinction manual workflows routinely miss, and one that has to be read out of each secondary payer's agreement rather than assumed. We do not publish a percentage of secondary revenue lost to that delay, because no free source measures one. The automated workflow tracks coordination of benefits (COB) across all coverage layers to confirm the full benefit hierarchy is used: Medicare primary with commercial secondary, commercial primary with Medicaid secondary, dual commercial coverage, Medicare Advantage with supplemental, and TRICARE scenarios. COB errors are caught at the eligibility verification stage rather than at claim submission, which prevents the rejection cycle entirely. For practices switching to MedPrecision with a backlog of unprocessed secondaries, the cleanup is scoped in the first 30 days of engagement and reported claim by claim rather than as a recovered total.
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