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Why You Need to Secure Your Claims Processing

Why You Need to Secure Your Claims Processing

Health insurance has been a highly debated topic over the past few years. With the Affordable Care Act, we have more insured Americans than ever before. 

With more people using various forms of health insurance, we also have more insurance claims to file. This often means that medical associations and individual practitioners are getting slammed with more and more paperwork. Medical billing can be overwhelming.

Medical claims processing can be a stressful ordeal, so let us help you figure out what you need to know.

How medical claims processing works

We live in a world where technology is expanding at unbelievable rates. With this massive growth, the way we do things is constantly changing. What was commonplace even a few years ago may be obsolete now.

The medical field is no different. While we all know that medical procedures have changed drastically over the past decade, many people don’t consider how much the work behind the scenes has changed.

Whether you have been in the field for years or are just starting, we’ll show you what you need to know.

The old way

Let’s start by looking at the traditional process of medical claims processing. We’ll paint the picture. 

It’s a Tuesday morning and you’re still working on claims from last week. You have a pile of files on your desk. They are medical claims that need to be filed with several insurance companies.

They are sorted into distinct piles based on where they should be submitted. It’s a lot to keep track of. You diligently fill out the forms. After a few hours, you can feel that familiar tension building between your eyebrows.

Now that you’ve started to make a dent in your first pile, it’s time to start correcting the older, rejected claims.

The first few go quickly. Silly mistakes, typos, and an incorrectly spelt name. You can’t believe you missed these the first time, but at least they’re easy to fix.

Suddenly, you get stuck on one. You can’t see anything wrong with the form and you’re not sure why they denied it.

You glance at your phone, then decide to set the file aside so you can deal with it later. You have too much to do to spend a half-hour on the phone with an insurance company right now.

By the end of the day, you’re even more behind than you were this morning. Then you see that file next to you. You forgot about it. So you call the insurance company.

20 minutes later, you still aren’t sure what went wrong, so you put down the phone.

If this sounds familiar, rest assured that there is an easier way. 

The new way

Now imagine it’s Friday and you aren’t behind at all. You started using a clearinghouse for your medical claims processing. The process seemed so different at first, but you’ve gotten used to it and now it feels like second nature.

You simply log into the clearinghouse and upload your files. After a few minutes, you notice that several were flagged, so you quickly go in and correct the problems. 

Then, the forms are sent to the insurance companies, so you don’t have to think about it much. 

In fact, you’re already getting reimbursed for claims filed a week ago!

You can do more claims quickly and you know that it’s secure and HIPPA compliant. You finally feel at ease.

Benefits of using a clearinghouse

The new way of medical claims processing simplified life for those of us who do regular billing.

Whether you’re an individual with a private practice or the head of a medical claims processing department that bills for many healthcare processionals, a clearinghouse can help you.

But a more enjoyable workday isn’t the only benefit of a clearinghouse. In fact, we have a list of ways this service can help you!

Fewer problems

Using a clearinghouse for your billing can drastically reduce the number of errors in your claims. In fact, the average error rate for claims submitted electronically through a clearinghouse is 25% lower than those submitted by paper.

Make changes quickly

When you do have an error that the clearinghouse catches, you can correct it quickly. Before it is submitted to the insurance company. This means that you are fixing the problem in a matter of minutes, rather than weeks.

An extra set of eyes

Since the clearinghouse catches so many little mistakes, you can trust that you’ll have fewer claims denied. It’s nice to have someone looking out for you! 

Batches of claims

Since clearinghouses do medical claims processing for a number of insurance companies, you don’t have to sort them on your own like you did when you submitted claims to each company separately. Instead, you can simply upload all of your claims at once.

Fewer headaches

For those moments when you do have trouble with something, you can be assured that you’ll have someone (other than the insurance company) to call for help. The customer services that goes along with a clearinghouse means you won’t have to figure out everything on your own.

Accurate picture of finances

Because the clearinghouse streamlines the process of medical claims processing, everything moves faster. Instead of waiting weeks or even months for an insurance company to reimburse you, you may only have a wait a few days. With less to keep track of, you’ll know where you stand financially on a more immediate basis.


You know that the clearinghouse uses HIPPA compliant procedure, so you don’t have to worry as much about potential violations.

Save money

Another important benefit of a medical claims processing service is the fact that it will save you money. Because of the streamlined process, fewer steps means you won’t need to spend as much time billing insurance companies.

With less time, you need as many people working on billing. A smaller staff means fewer expenses.

Next steps

Now that you’re ready to work with a clearing house for your medical claims processing needs, what’s next?

Choosing a reliable company is absolutely crucial when you’re dealing with sensitive medical information. Make sure you’re in the right hands.

We offer a free live demo of our software, so you’ll know exactly what you’re getting before you commit. If you have any questions, don’t hesitate to contact us.

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Claims Processing: Could My Claims Be Returned by the Insurance Company? Why?

Health Insurance Denied Form Showing Unsuccessful Medical Application

Claims can be returned for a variety of reasons. The most common cause for a rejected claim is missing or inaccurate information. For example, errors in patient data such as the date of birth, age, sex, address, or name will cause an immediate return. Then there is provider information and insurance identification numbers, which can be easily and unintentionally misrepresented.

When the insurance company payer receives a claim, they check to make certain the patient is covered by the policy and all treatment codes match the appropriate diagnosis. Sometimes preauthorization records, referring physician identification numbers, or evidence of medical necessity is left incomplete.

The use of a medical claims processing software ensures all required information is included in the claim, prior to submission to the insurance payer. The software will catch any obvious errors such as missing or invalid information easily. The best way to increase claim payments is through prevention, submitting a clean claim the first time without any errors.

A medical billing software solution is well worth your investment. Apex EDI wants to simplify claims processing for you, so you can get paid faster. Contact Apex EDI to watch a free demonstration of our software today.

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Claims Processing: What is Claims Adjudication?

After a medical claim is submitted, the insurance company determines their financial responsibility for the payment to the provider. This process is referred to as claims adjudication. The insurance company can decide to pay the claim in full, deny the claim, or to reduce the amount paid to the provider.

When an insurance companyAdobeStock_94630507 decides to reduce a payment to the provider, they have determined that the billed service level isn’t appropriate for the diagnosis or procedure codes. Therefore, it is important to ensure that all claims submitted for payment are coded accurately.

As soon as an insurance company receives a medical claim, they begin a thorough review. Sometimes even small errors such as a misspelled patient name may cause a claim to be rejected. This delay prevents you from receiving payment while corrections are made.

When claims are submitted electronically, the software can help prevent errors such as incomplete or inaccurate information before it is submitted for payment. This helps increase the speed at which you can be reimbursed for services.

Once claims are received by the insurance company, the review continues with detailed analysis of the insurance policy. Some claims are even checked manually by medical examiners who examine medical documentation to determine if procedures are medically necessary.

When the claim has passed through the review process, it can finally be paid. Having a claims processing partner, like Apex EDI, to prevent errors in claim submissions helps you get paid quickly. Contact Apex EDI to watch a free demonstration of our software today.

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Claims Processing: How to Avoid Claim Denials

Medical Claims Denial appeals formThe best healthcare practices know that managing claims and avoiding unnecessary claim denials is a crucial part of the business. Errors, oversights, and delays in processing can cause more  than you might think. To have an immediate impact on your business make improvements in these three areas.

All claims must be legible. Even claims printed electronically can get messy, smudged, or blurred from printers and scanners which can create a huge problem for payers. Payers must be able to read and scan claims into their system immediately upon receipt for you to get paid quickly.

Make sure all claims are detailed and specific about the care received by the patient. It’s uncommon for claims missing facts such as the date of the accident, emergency or onset of the medical condition to be denied. It’s important to answer each and every question on a medical claims form.

File all claims in a timely manner. This can get complicated to manage because each insurance carrier operates under its own guidelines and payment schedule. Carriers will deny claims that are simply not received within their payment window stipulated. When you are working with a number of different insurance carriers, you can quickly see the benefit of working with a medical claims processor like Apex EDI.  

Apex EDI works with providers to carefully manage insurance claims and make sure all filing deadlines are met for multiple payers. This allows you to get paid fast and stay focused on providing excellent patient care. Contact us at Apex EDI for a free demonstration today.

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Claims Processing: Why Doctors Should Monitor Medical Claim Status

Doctor fees

Most doctors have experienced some medical claims headaches at some point in time. The routine monitoring of patients’ medical claim status can help you prevent potential problems or claim denials before they occur. The likelihood that you will ever receive a payment drops significantly if your claim is denied once.

You can save a lot of time by using an electronic medical billing software system. Electronic transactions and standardized reports make it much easier to ensure payments for health services are accurate. Automated computer billing rules can spot problematic claims before they are submitted.

Then, of course, no one likes to follow up on late payments, but if you delay you are much less likely to receive full payment for services rendered. Medical billing software can simplify the process of tracking receivables and monitor underpayments to ensure that you follow up quickly. It also ensures that you stay compliant with ICD-10 regulations.

A good software tool gives you the ability to spot problems at a glance. You will be able to catch errors, see the status of all claims and know when you need to follow up right away. We want to make this process easy for you and free up your office staff’s time to care for patients.

At Apex EDI our supportive, highly skilled staff is always ready to assist you. We want you to get paid on time for every patient’s medical claim. Contact us at Apex EDI to request a software demonstration today.

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