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Are Claims Management Companies Worth It?

At Apex EDI, we’re interested in helping you find the best solutions to your medical claims issues, and avoid pitfalls that cost you time and money over the long run. We know that the world of insurance can be confusing and intimidating, so we want to help pull back the curtain a bit on what goes on behind the scenes of filing insurance claims.


Something we get asked about a lot are the viability of claims management companies, companies that file complaints against financial institutions on behalf of a client. They go after these financial institutions for you for unpaid claims and disatisfaction with service, and promise great large and timely compensations.

These claims companies will do all the work for you. They will represent you to the company that you are filing a complaint against and fight on your behalf for the highest payout possible. They employ professionals who know the ins and outs of how to settle disputes with financial institutions, and may have more insight than you do into the value of your claim.

Financial institutions have an incentive to keep their liability as low as possible, and it can be difficult for a lay individual to catch them in the act or know how to combat them effectively. Hiring a claims management company can help you get the best payout possible. If you choose to use a claims management company, make sure that it is a reliable one. You can vet the company by checking that it is regulated by the Ministry of Justice and a member of a professional body.

Looking for more professional help with claims? Filing insurance claims is our specialty at Apex EDI, and we offer the professional support and high tech features you need to save time and money on processing your medical, dental, or vision claims. Contact us today to learn more about how we help you get the most out of your team and your software by making it easier than ever for you to reduce the number of denied and rejected claims you receive.

Posted in: Apex EDI, EDI, Medical Claims

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The 5 Keys to a Successful Claim

Apex EDI is dedicated to simplifying claims management. Laying a good foundation with some basics steps to a good claim can help reduce stress and lead to a better result, so we’ve gathered 5 helpful keys to successfully filing a claim.

Wooden Blocks with the text: Claims

1. Determine Your Priorities

The first step to successfully managing a claim is setting a goal for what you want to accomplish through the process. Does a larger settlement outweigh a faster one? Are you more interested in the claim being processed smoothly or are you looking to generate cash flow? Your goal for the claim will help you and your team make decisions throughout the process.

2. Have a Team of Professionals Ahead of Time

Your insurer has a team of experts who know how to reduce their responsibility to you as much as possible. Because of this, it’s important that you, too, have a team of experts that can help you evaluate the responsibility of the insurer to your benefit and combat the team that the insurance company has put together. Having these people available and organized before you need them is ideal.

3. Have a Plan

It’s important to have a well-laid plan of how you’re going to deal with claims ahead of time to ensure that all steps are taken care of and all requirements are met throughout the claims process. Talk to claims management professionals to help you develop your plan, and engage with them when you need to argue a claim.

4. Prioritize Your Claims

Claims take time and attention to process correctly. Prioritize your claims by investing your time and money on the front end so that you don’t end up paying for it over the long term. Having dedicated employment for such matters, or hiring a third party to help deal with it for you, will be your best bet in ensuring that you get what is owed.

5. Manage All Your Information

Incorrect or incomplete information can cause a claim to get dragged on for much longer than it needs to be. Ensuring that you have all the correct information up front and double checking for errors can save you a lot of time and money in the long run.

When filing medical claims, it’s important not to waste time on mismanagement of claims. Let the professionals at Apex EDI clearinghouse help you get better results faster, and with less expense to you. Our feature-rich claim filing programs will help you get the most out of your billing team and your filing software, all at a competitive price. Learn more about what we have to offer by contacting us or visiting our website.

Posted in: Dental Claims, Medical Claims, Wellness Claims

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5 Things You Must Know About Denied or Rejected Claims

Denied and rejected medical claims result in substantial financial losses for medical, dental, and vision practices. This is why it’s important to stay vigilant about these denied and rejected claims and keep on top of resolving them. Here are a few things that you should know about these claims that will help your office better deal with them.


1. The Difference Between Denied and Rejected Claims

Denied and rejected claims are not the same. A denied claim is one that is determined unpayable by the insurance company. Sometimes these are due to error on the part of those submitting the form and sometimes it is due to patient ineligibility for services rendered. Either way, the insurance company will let the office know what the reason for denial was on the Explanation of Benefits (EOB).

These claims can be appealed, but it’s better to try and avoid these if possible. A rejected claim is sent back due to errors, and is simply resubmitted with corrected information. Because constantly appealing and re-submitting denials and rejections can be costly and time consuming, it’s worth investing time and resources into ensuring claims are filed successfully the first time.

2. The Most Common Reasons for Denials and Rejections

Insurance companies have very strict requirements when it comes to how claims should be filed. Some of the most common reasons for rejections include incorrect service or diagnosis codes, missing or incorrect patient information, and insurance specific requirements that aren’t met. Hiring a reliable clearinghouse, like Apex EDI, that can scrub for errors and keep track of insurance specific requirements will help you avoid these errors, and save you time and money in the long run.

3. How to Resolve Issues Quickly

Many claim errors are made because of imperfect or out-of-date information somewhere along the line between scheduling an appointment and submitting the claim. Small oversights such as failing to consistently ask patients about changes to their insurance or patient information during sign in, or failing to keep up to date with insurance-specific requirements can lead to many unnecessary denials and rejections.  Communication is key to ensuring that the most correct information is always used on claims.

4. Trends in Your Denied and Rejected Claims

Keeping track of trends in denied and rejected claims can help you catch repeating issues. By digging a little deeper you may find that a specific code or repeated error may be to blame for a large number of denied or rejected claims, and you may be able to significantly reduce the time and money you spend on resubmitting by simply resolving the error for future claims.

5. How Apex EDI Can Save You Time and Money

Using a reliable, hard working clearinghouse can help you reduce administrative costs, reduce the number of denied and rejected medical claims you have to deal with, and save you the time and money that is often lost through mismanaged claims. We have a feature rich program that makes it easier than ever for you to file your claims and catch mistakes the first time. Click here to discover all the features we offer and to learn more about how we can help you get paid faster with fewer headaches.

Posted in: Apex EDI, EDI, Medical Claims, Uncategorized

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How Are Medical Claims Processed?

File Folder Labeled as Claims in Multicolor Archive. Closeup View. Blurred Image. 3D Render.

Once medical services have been administered to a patient, payment needs to be requested from insurance through appropriate channels. These requests for payment are known as medical claims, and to the lay person, filing them may seem rather complicated. We’re hoping to demystify this process by breaking down the way medical claims are filed and paid.

Each service rendered to a patient has a designated code so that the payer will be able to reference them against codes and services the patient is eligible for. These codes along with insurance and patient information make up the bill that is sent on to a clearinghouse on its way to the patient’s insurance provider. Medical bills are often processed and submitted through online channels because it saves time and money, but hard copies are still available and occasionally used for this process.

This is where Apex EDI comes in. Forms are sent through clearinghouses like Apex EDI before being sent on to the insurance company so they can be scanned for errors and reformatted to comply with HIPAA and insurance company standards. Clearinghouses like ours are necessary because each insurance company has different standards, and doctors offices are responsible for submitting high volumes of claims to different insurers on a daily basis. Without a clearinghouse, the strain on the billing department of the office would be astronomical.

The doctor’s office chooses which clearinghouse it works with, and it’s important to select one that works with the insurance companies you work with, can work with the software you have available, and is reliable. Luckily, we at Apex EDI work with many different insurers as well as many different software programs. Visit our website or give us a quick call to see how we go above and beyond to serve all of your medical, dental, and vision claims needs. Choose Apex EDI to help you get your claims filed faster, get paid faster, and take the stress out of the claims filing process!

Posted in: Apex EDI, Medical Claims

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A Typical Visit: What your Physical Therapy Claim will Pay For

Physical therapists work with patients to increase strength, flexibility and movement following an illness or injury that results in a change in your physical movement. Seeing a therapist can help you get back to the daily activities you enjoy with a comprehensive recovery treatment plan. You will start with an evaluation to assess your injury and change in physical function.

During the first visit, you can expect to be asked about the history of your illness or injury and a number of questions about your symptoms. The therapist will perform tests to evaluate your range of motion, strength, flexibility, posture and mobility. The therapist will also explain your condition and the rehabilitative treatment plan designed for you.


Therapists are skilled at treating pain and discovering the underlying cause for it. Addressing the muscular issue causing the aches and throbbing you experience is critical to restoring pain-free movement. You will work closely with the therapist to describe the intensity, frequency and duration of any pain you experience.  

A treatment plan may include a combination of therapeutic exercise, “hands on” massage, stimulation of the body with heat or cooling and education about physical activity. Many therapists rely on the patient to perform at home exercises before and after treatments to ensure you regain movement quickly. The actions you take at home will help you recover quickly.


Most physical therapists can also offer advice for preventing future injury. This may include the design of living and work spaces to prevent pain from repetitive movements and preventative exercise routines.  Most forms of physical therapy treatment are covered by insurance.

Apex EDI helps get your physical therapy insurance claim paid quickly so you can return to the physical activities you enjoy.    

Contact us today to learn more.  

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

Posted in: Physical Therapy Claims, Wellness Claims

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