Claim
Submission

Claims that have been prepared need to be aggregated and sent out to the insurance carriers for processing. This should ideally be once a day - if real time is not possible. Once this process has been initiated, two levels of checks are performed prior to actual receipt by the carriers: Billing System Rejections and Clearing House Rejections.

Billing System
Rejections

The first level of claim checks is performed by the billing system. The system cross checks claims being sent against rules it has created to identify issues that will lead to a denial. When certain claims deviate from programmed rules, these claims will be kicked out. We will work these scrubbed out claims, addressing and correcting any issues, and prepare these claims to be resubmitted.

Clearing House
Rejections

The second level of claim checks happens at the clearing house level. Clearing houses are platforms that convert claim files into the respective file format of the intended carrier. As carriers tweak their accepted file formats, clearing houses keep up with these technical changes. By extension of this pass through of claims, at a national level, clearing houses have built rules to identify claims that will likely deny, if received by the carriers. We work these kicked out claims similar to Billing System Rejections, addressing any issues and preparing those claims to be resubmitted.