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Medical claim submission, checked line by line before release.

Most rejections come from small errors: a wrong subscriber ID, a missing modifier, a diagnosis pointer on the wrong line. We check every claim before releasing it to the clearinghouse, and fix the ones that still come back.

Talk to our billing team How we work
Checked on every claim
  • Member and insurance details✓
  • Diagnosis codes and pointers✓
  • Modifiers✓
  • Procedure code for the place of service✓
  • Units, charges and provider NPIs✓
The short answer

What is the difference between a rejected claim and a denied claim?

A rejected claim never reached the insurer's payment system. The clearinghouse or the payer turned it away because of a format or data error, such as an invalid subscriber ID or an invalid diagnosis code. It has not been processed, so the fix is to correct the error and send it again.

A denied claim was received and processed, and the insurer decided not to pay it, for example because an authorization was missing or the filing deadline had passed. A denial needs a corrected claim or an appeal. We cover that on our denial management page.

Claim submission is the step that prevents both. Once your providers enter claims in the billing software, we check each one, then release it to the clearinghouse for the right payer. When a rejection comes back, we read the rejection code and message, find the exact cause, correct it and resubmit through the right portal.

How we work

How we submit claims and fix rejections.

Every rejection has a different cause, so we investigate each one instead of resubmitting blindly.

  1. 1
    Review the claimMember and insurance details, diagnosis codes and pointers, modifiers, procedure code for the place of service, units and billed amount.
  2. 2
    Check the providersBilling, rendering and referring provider names and NPIs.
  3. 3
    Release to the clearinghouseOnce every field is confirmed, we release the claim to the clearinghouse for the right payer.
  4. 4
    Fix rejectionsWe read the rejection code and message, find the cause, correct the claim and resubmit it through the appropriate portal.
What is included

Common rejections we fix.

Member errors

  • Invalid subscriber ID
  • Member details that do not match the payer

Coding errors

  • Invalid diagnosis code
  • Procedure code inconsistent with the modifier
  • Procedure code not valid for the place of service
  • Diagnosis pointer on the wrong line

Provider errors

  • Wrong billing, rendering or referring NPI
  • Provider name mismatch

Charge errors

  • Wrong units
  • Wrong billed amount
Working time

Average time we spend on each item

TaskAverage time
Simple rejection fixed and resubmitted10 to 15 minutes
Rejection that needs a call to the payer20 to 30 minutes

This is hands-on time per item, not a promise of when your whole queue is cleared. Queue timing depends on your volume and is agreed with you at the start.

Systems

Systems we submit claims through

  • NextGen Office
  • SimplePractice
  • Availity
  • Payer portals (UHC, Aetna, Cigna, BCBS)
  • Medicare and Medicaid portals

Using something else? Tell us which system you use. We will say plainly whether we have worked in it before.

Patient data

We sign your Business Associate Agreement before we see any patient data.

Our parent company, Hire My Assistants KPO LLP, is HIPAA compliant.

Your BAA, signed

We sign the Business Associate Agreement your practice or plan uses, before any access is set up.

Work in your systems

We work directly in your billing or claims system, or through the VPN or virtual desktop you provide. We never download or store patient data.

A controlled floor

Restricted, monitored workstations, multi-factor login, encrypted devices, and access logs. No phones or writing material on the floor.

Checked and trained staff

Every team member passes police verification and an outside background check, and completes HIPAA training when they join the team.

Questions

What practices and plans ask us.

What do you check before releasing a claim?
Member and insurance details, diagnosis codes and pointers, modifiers, whether the procedure code fits the place of service, units and billed amount, and the billing, rendering and referring provider names and NPIs.
What does "releasing a claim" mean?
On the provider side, claims sit in the billing software until someone sends them to the clearinghouse. Releasing a claim is that step. We release claims only after checking them.
How long does it take to fix a rejected claim?
A simple rejection takes 10 to 15 minutes to correct and resubmit. When we need to call the payer, it takes 20 to 30 minutes.
Is a rejection the same as a denial?
No. A rejected claim was turned away before processing because of a data error and can be corrected and sent again. A denied claim was processed and refused, and needs a corrected claim or an appeal.

More medical billing services

Medical Billing Services Eligibility Verification Prior Authorization Denial Management & AR Follow-up Payment Posting & Recoupments Provider Credentialing Claims Processing for Payers Member Enrollment & Terminations
Get started

Let us check your claims before they go out.

Tell us your billing software, your claim volume and your most common rejections. We reply within one business day.

  • We sign your Business Associate Agreement
  • US business hours, overnight or 24/7 shifts
  • $9 an hour, one rate for all billing work
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