Medical Claims Submission Services
Daily electronic filing, with rejections worked the same day they come back.
Claims submission looks like the simplest step in the revenue cycle and it is the one most often measured wrong. The question is not whether claims went out. It is whether each claim was acknowledged by the payer, and what happened to the ones that were not.
Between your practice and the payer sit a clearinghouse and the payer’s own front-end edits, and a claim can be stopped at either. Those stops produce acknowledgement files that many practices never open. The claim is gone from the PM system, so it looks submitted, but it is nowhere on the payer’s books.
We submit daily, reconcile every batch against its acknowledgements, and work anything that did not make it through on the same day.
The problem
Where this usually goes wrong
Claims that look submitted but never arrived
A claim rejected at the clearinghouse leaves your system and never reaches the payer. Unless someone reconciles acknowledgement files, it sits in limbo until the filing deadline quietly passes.
Batching instead of filing daily
Weekly submission adds days of float to every claim for no benefit. Payment timing follows submission timing, and the delay compounds across the whole month.
Secondary claims never filed
After the primary pays, a secondary claim has to go out with the primary remittance attached. This step is skipped constantly, and the balance either sits in A/R or lands on the patient incorrectly.
What is included
- Daily electronic submission to all contracted payers
- Clearinghouse and payer acknowledgement files reconciled against each batch
- Front-end rejections worked and resubmitted the same day
- Secondary and tertiary claims filed automatically once the primary posts
- Paper claims and attachments where a payer still requires them
- Corrected and voided claims filed with the right frequency codes
- Workers compensation and personal injury claims with their documentation
- Submission and acceptance rates reported by payer each month
How it runs
Our process
- 1
Build and submit daily
Scrubbed claims go out every business day. Nothing waits for a weekly run, because float added at submission is float you never get back.
- 2
Reconcile acknowledgements
Every batch is checked against the clearinghouse and payer acknowledgement files. A claim is not treated as submitted until the payer has confirmed receiving it.
- 3
Work rejections same day
Anything stopped at the front door is corrected and resubmitted that day, while the reason is still fresh and the filing clock has barely moved.
- 4
File secondaries
When a primary remittance posts, the secondary claim goes out with it attached. This is automatic rather than something that depends on someone remembering.
- 5
Report acceptance
Monthly acceptance rate by payer. A payer whose acceptance rate is drifting down is usually signalling a rule change worth investigating before it becomes a denial trend.
Questions we get asked
How often do you submit claims?
Every business day. There is no reason to batch, and each day of delay moves the payment date and the filing deadline by the same amount.
How do you know a claim actually reached the payer?
Acknowledgement files. Each batch is reconciled against the clearinghouse response and the payer acknowledgement, so a claim counts as submitted only when the payer confirms it, not when it leaves the PM system.
What happens to rejected claims?
They are corrected and resubmitted the same day. Rejections are the cheapest problem in billing to fix and the easiest to lose, because they never show up in denial reporting.
Do you file secondary insurance claims?
Yes, automatically once the primary remittance posts, with the primary explanation of benefits attached. Unfiled secondaries are one of the most common sources of aged balances we find during an audit.
Can you handle payers that still want paper?
Yes, including claims that need supporting documentation attached. It is a shrinking list but not an empty one, particularly in workers compensation.
Do we need a new clearinghouse?
No. We work with your existing clearinghouse and payer enrolments. Changing clearinghouse is a separate decision and rarely a necessary one.
See what your practice is leaving on the table.
We look at 90 days of your claims data and tell you what is recoverable. No cost, no obligation, BAA signed before anything changes hands.
- Recoverable dollars in your aged A/R, as a number
- Denials grouped by root cause, ranked by value
- A written summary you keep either way
Prefer to talk? (301) 786-0552
Or email info@asesormd.com