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Medical Claims Processing: 5 Steps to Retool Your Practice

Watch Your Balance Sheet

Until your practice’s business processes have proven themselves, you should be prudent about spending. Focus on your core strengths and partner with value added suppliers to enable your practice to grow and succeed.

Listen to Your Patients

Feedback, especially the kind gathered from personal conversations, is essential to figuring out how and when a practice should make a change. Physicians and administrators need to ask patients what’s working and what’s not and not rely on their gut alone.

Keep an Eye on the Stats

Track and analyze key indicators for your practice. Work with partners who can help you use your business software to monitor the success of your practice. These statistics will help you know when you need to make a change.


If possible, you should test a new business strategy while preserving the current business model—just in case the new model turns out to be less effective than hoped for. Allow your practice to evolve and grow.

Be Open to Change

To allow a practice to evolve and grow, doctors must set aside their personal beliefs about the practice or its processes. There is a myth that stubbornness and raw determination are good traits for a small business owner. The truth is that tenacity and willpower are good for getting started, but then they can often get in the way of getting to the next level.

About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

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Medical Claims Processing: 5 Insider Tips to Get Claims Paid—Fast

For the past 15 years, we have helped many practices get paid faster and with more accuracy. We've found some best practices and insider tips to help any practice improve their insurance reimbursement. Just to clarify, we're assuming that you already send your insurance claims electronically. If you're reading this, you probably found it on the Internet. Which means you already understand the value of the Internet on your practice.

In no particular order here are 5 ways to get claims paid quickly:

Get Serious about Tracking Claims

Make sure your clearinghouse offers a simple way to track your sent claims. You should verify that:

  • Claims are received by the clearinghouse
  • Claims are successfully processed and sent to the payer
  • Additional payer requirements (like requests for more information, or attachments) are met

This may sound like a lot of work, but a good clearinghouse will automatically provide this information to you.

Ask for the EDI Department

Nothing is more maddening for a practice then to hear the words—we never received your claim. An office can see that the claim has obviously been sent and the clearinghouse has record of sending the claim, but you have to make sure you are speaking to the right people.

When you call an insurance company you usually speak with the customer service department. When they say they never received a claim, that may be true. Your claim may be held up in the payer's EDI (Electronic Data Interchange) Department where the customer service department can't even see it yet. One easy trick is to ask to speak with the EDI department. This department makes sure the data has arrived safe and sound. They control the inflow and integrity of the information.

So by simply asking to be transferred to the right department, you will avoid a lot of frustration.

Set Up Direct Deposit

You already receive your paycheck this way, but your business has to wait for funds the old fashion way? You can do better by using the direct deposit options offered by most insurance companies. Some of our clients have experienced lightning fast claims reimbursement by using eClaims to deliver, and direct deposit to receive. Amazingly some offices have seen a complete turnaround from patient to paycheck in only 4 days! Admittedly, this is still the exception, but the concept is sound. Call your insurance specialist to enroll. It is absolutely the best way to get paid fast.

Take Time to Learn the Lingo and Read the Reports

Many practices mistakenly skip over important reports that are trying to tell you what you need to know. Out of desperation and a simple lack of understanding, billing professionals may be skipping over critical data. It's the classic example of being too busy driving to pull over and get gas—at some point it will catch up with you. It is important that you read and understand the information your billing partners are sending you. If reports just aren't making sense then consider the next step.

Keep Training Fresh and Consistent

Often someone becomes the office billing expert by being thrown into the position with little or no training. A simple way to avoid the training gap is to take advantage of free trainings offered.

Quality software, clearinghouse, and insurance partners offer refresher trainings for any new or fill in employees. This is a simple add on to ask for when purchasing your software or joining a clearinghouse.

You can also make sure the billing staff has adequate continuing education. People quit, get sick, or get overwhelmed, and often someone needs to step in to learn the ropes quickly. With such a menu of webinars and online content available, you can easily find something that matches your philosophy and refer back to it as the staff changes. The local chapter of your industry association can help you.

Use these tips to see how you can speed up reimbursement in your practice.

Posted in: Medical Claims Processing

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