Claims Submission & Charge Entry
Clean, complete, and compliant claims—submitted fast to keep cash flowing. Eligibility checks, coding validation, payer edits, and rejection handling with full transparency.
Where We Help
- Patient registration & eligibility/benefits (real-time where supported)
- Charge capture & charge entry with coding validation (E/M, modifiers, NCCI)
- Claim scrubbing against payer edits and clinic-specific rules
- Clearinghouse monitoring & rejection work within 24–48 hours
- ERA/EOB checks to confirm posting accuracy and underpayment flags
Engagement Models
- Dedicated Intake Team: daily charge entry with eligibility & pre-scrub
- Hybrid: clinic coding + Carenox submission & rejection rework
- Full-Service Billing: end-to-end from charge entry to collections
- After-Hours / Weekend Coverage: keep DSO low with continuous flow
- Go-Live Pods: short pilot to stabilize edits before scaling
Quality & Controls
- AQL sampling by payer & claim type with calibrated reviewers
- Shadow → solo → peer-review ramps; checklists embedded in playbooks
- Weekly drift checks with denial trend feedback loops to coding/front desk
- Evidence tiles linking claims to validations and corrections
- Change control for SOPs; versioned training records & access reviews
Onboarding & Pilot
- Intake: data snapshot (top denials, AR buckets) & workflow mapping
- Access: least-privilege/JML workflow; BAA and user provisioning
- Pilot: 2–4 week plan with clean-claim thresholds and rollback criteria
- Steady state: WBR/MBR cadence, SLA dashboards, continuous improvement
- Scale/exit plans: knowledge capture, asset return, and sign-offs
KPIs We Track
- Clean Claim Rate (first-pass acceptance)
- Submission Turnaround (charge entry → payer submit)
- Clearinghouse Rejection Rate & rework TAT
- Underpayment flags & resubmission yield
- Stakeholder CSAT and escalation rate
Related RCM Services
Denials
Denial Management
Root-cause analytics and payer-specific appeals.
ExploreCollections
Accounts Receivable
Worklists for 30/60/90+, escalations & outreach.
ExploreAccuracy
Coding Accuracy & Audit
NCCI, LCD/NCD, modifiers; audit & feedback loops.
ExploreEnrollment
Credentialing
Payer enrollment & revalidation tracking.
ExploreEngagement
Charge Entry Pod
Daily charge entry + eligibility + scrub; rejection handling in 24–48h.
ExploreEngagement
Full-Service Billing
From charge capture to collections with SLAs, QA, and dashboards.
ComparePath
Go-Live Pilot
2–4 week pilot with success thresholds and roll-back criteria.
Start AssessmentStart in weeks, not months
We’ll propose a pilot with metrics, QA, and success thresholds tailored to your payers and specialties.
