Electronic Claims Submission

ABCLLC submits all claims electronically within eight hours from the encounters or charge files received. Electronic claim speeds up  claim processing times. It provides a confirmation that the claims have reached the payer on time. Electronic claims reduce rejections and denials drastically. ABCLLC can work with different kinds of clearing house. Many payers have very strict claim filing time limits. Electronic claim filing helps to stay on time and enhance cash flow. Before the claims are submitted the following checks are made

  • Appropriate modifiers are added to the CPTs 
  • High specificity diagnosis are added by cross checking the progress note
  • Reminders sent to providers before claim submission if the claims are created without the completion of progress note

Clearinghouse Rejections and Batch Checking

 Clearinghouse generates payer acknowledgement and rejection report for every claim batch submitted. These reports are analyzed line by line and erroneous claims are fixed and resubmitted. These reports help us to improve operational efficiency. Electronic claims submitted are commonly scrubbed for payer, specialty and coding rules. ABCLLC work on rejected claims immediately and resubmit them with required corrections. After submitting the claims electronically batches are checked in clearinghouse portal to confirm if the claims are accepted by the payer and clearinghouse.

Medical records request and submission

  • Medical records requested by payer or downloaded directly from the hospital portal rather than relaying on the practice
  • Medical records request are submitted directly through insurance portal 
  • All worker compensation claims are submitted with medical records in first submission
  • Separate invoice is created for attorney offices requesting medical records. Medical records are sent after the payment received from the attorney offices
  • Weekly reminder sent to the provider to complete unsigned medical records 

Claim submission comparison with others

Claim Submission ABC LLC Others

Claims are submitted within 8 hours from claims created

Everyday clearinghouse and payer rejections are fixed
and resubmitted

Everyday manual claims scrubbing is done

Everyday claims submitted batch are checked for errors

All worker compensation claims are submitted with
records in initial submission

Most appropriate diagnosis is picked from the progress note to match
the procedure before claim submission

Medical records downloaded from hospital portal
or requested through fax or phone

Missing CPT's and Dx's in a completed progress note is
communicated with the provider to fix it

Weekly reminder sent to the provider to complete
unsigned medical records

Insurance medical records request by letters
are submitted through Insurance portal

Invoice created for Attorneys who request medical records
and payment collected before sending the medical records