Claims Submission

Simplify Claim Submissions Process for Easier, Hassle-Free Reimbursements

Claim Submission Service simplifies your medical billing process by carefully handling every step of the submission of claims. We validate patient data, check coding and compliance, and ensure proper initial filing by using the electronic method. This reduces denials, speeds up payouts, and allows you to focus on providing excellent patient care and growing your practice.

claim submission process in medical billing

One of the critical steps involves the submission of claims by healthcare professionals to payers or insurance companies so that they can be paid for services delivered. This step requires an accurate report of medical records with procedure and diagnosis codes, along with their corresponding expenses. This claim may be filed in an online method, which is also known as electronic claim submission.

Processing primary claims submission includes a patient who has coverage by insurers such as Cigna, Aetna, Elevance Health, or United Healthcare and requires adhering to their particular procedures. 

Accurate and on-time submission of claims is the basis of medical billing. This way, all claims get processed quickly and effectively, which leads to a reduction in errors, rejections, and delays. This will help medical professionals get paid quickly and promote effortless operations.

Key Components of a Claim Submission

Accurate Patient Information

Collecting detailed patient data is crucial for claim submission. This data includes the patient’s demographics and insurance demographics, or any other important information. Verifying accuracy is essential to avoid delays and denials.

Accurate Provider’s Information

Information about the healthcare provider, such as name, mailing address, and National Provider Identifier (NPI), is essential. This ensures the claim is credited to the right provider’s payment posting address, especially when the claim is submitted to insurers like United Healthcare, Aetna, or Cigna etc.

Accurate Insurance Information

Accurate insurance details, including policy number or subscriber ID, are crucial. Correctly capturing these elements ensures the claim is submitted to the right payer, reducing denials. Verifying insurance data thoroughly to avoid processing setbacks.

Pre-authorization

For certain services, obtaining pre-authorization from the insurance provider is necessary. This confirms that the insurance company ensures to cover the costs before services are provided, preventing issues during claim submission.

Treatment Codes

Accurate coding with ICD-10 and CPT/HCPCS codes is vital. We check that these codes clearly convey the medical necessity of services provided. Correct coding reduces errors and denials, ensuring timely reimbursement.

Administration Details

The date, time, location, and specifics of services must match the patient’s medical records. For electronic claims, this information is sent via standardized formats like ANSI 837 to ensure compatibility with payer systems. Proper documentation minimizes errors and supports timely processing.

Data Security

It’s crucial to keep patient data safe during the claim process, which includes personal details. Using secure electronic systems ensures this information is protected and follows HIPAA rules.

Claim Submission Process in Medical Billing

Step- 1

Verification of Insurance Eligibility

Verify patient's insurance eligibility to see if the services to be provided are covered to avoid denial of claims.

Step- 2

Complete the pre-authorization process

Ask for the necessary approvals or authorization from the insurer or payer before providing services.

Step- 3

Correct patient and provider information on claims

Evaluate all the information about the patient and the provider is correct on the claim to prevent processing errors and to ensure proper reimbursement.

Step- 4

Patient’s Encounter: ICD-10 and CPT Codes

Accurately use of ICD-10 and CPT codes to detail the patient’s diagnosis and treatment, supporting the claim's validity.

Step- 5

Timely File Your Claims

Submit claims promptly to ensure they are processed quickly and effectively, so that claim will be reimbursed on time.

Outsource your claim submission process to Doctorsbackoffice

Improve your revenue cycle with DoctorsBackOffice's excellent claim submission services. Maintain precision and quickness. Allow us to handle your claim submission process today!

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Frequently Asked Questions

1. What is a claim submission?

A claim submission is a request to the insurance company to provide insurance coverage for services provided. It includes detailed information about the services, the patient, and the insurance coverage.

2. How long does it typically take for a claim to be processed?

Basically, a claim may take the longest to process based on its character, the pace of the insurance company in processing, or if some extra information needs to be required. Generally, a few days to several weeks is what it takes to process a claim.

3. What documents do I need to submit with my claim?

Required documents in a claim submission vary from case to case. However, they generally include:

  1. A completed claim form
  2. Medical records, including diagnosis codes and procedure codes
  3. Bills or invoices for services rendered
  4. Insurance identification cards
  5. Any supporting documentation, such as police reports or accident scene photos
4. What should I do if my claim is denied?

In case a claim is denied, one should rectify the reason for the denial and gather more information or correct documentation. You may even want to reach out to your insurance company regarding denial to debate and point out the possibility of appeal.

5. What are the two most common claim submission errors?

1. Incorrect or missing patient information

The most common ones concern the information dealing with the patient: names that are misspelled and dates of birth that are incorrect, or insurance policy numbers that do not even exist.

2. Incorrect or incomplete coding

Another very common problem arises concerning medical coding errors; these errors may be generated by the use of the wrong ICD-10 diagnosis code, or the CPT/HCPCS procedure-coding code. Sometimes, this error in coding can be because the personnel did not understand the medical procedure entailed; at other times, it is just simple human error in the use of outdated codes.