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4 Keys to Submitting Claims Successfully

Doctors and billing team working together to submit claims more successfully.

Submitting claims requires an A-list clearinghouse. Let’s face it. The claim management process is quite tasking, and without the right intermediary, getting what is due to you can be an uphill task. 

A slight delay or an unsuccessful claim could mean poor cash flow for your organization. In today’s post, you’ll discover what it takes to file a successful claim. We’re persuaded you’ll find this helpful and that it’ll positively influence your bottom line. So, let’s get started! 

1. Make Payments a Priority 

Cash flow is the bloodline of every successful organization. Without adequate funds, it’s more like a blood clot blocking the vessels and hindering the free flow of blood.  Because of inadequate funds, your organization can be paralyzed in its operations. 

However, you can easily avoid this problem by ensuring your Revenue Cycle Management (RCM) is top-notch and there are no loopholes. If you’re always encountering a shortage of funds as an organization, perhaps it’s time you fixed your RCM. 

Now, how do we go about that? The key is prioritizing insurance billing. Of course, patient care is number one, but your team should understand how important proper claim processing is to getting the revenue that allows you to continue your care. Make sure you’re emphasizing throughout the care journey what steps are important to take to ensure your billing team is set up for success. Smoothly processing your patients’ insurance claims can also save those you’re caring for a huge amount of headache. Make sure all claims are submitted correctly. If there’s a problem with claims you’ve submitted, you rework them then resend them as soon as possible. 

Lastly, you want to follow up on payments to make sure they’re processed on time. If you stick to this plan, there’s no reason to experience financial shortages that can paralyze your work. What follows is, everyone is happy—patients are well taken care of and staff is satisfied. 

To help with this, and to make sure you don’t have to redirect too much of your doctors’ time from treating patients, partner with an insurance claim clearinghouse like Apex EDI. With a clearinghouse partner taking care of insurance claims processing and cutting out unnecessary delays in your revenue cycle, you can get back to what matters most.  

2. Trust the Experts 

Working with not only a knowledgeable, but an experienced staff is perhaps the best way to getting the most out of your insurance billing.  

The best way to ensure your claims are submitted successfully and with minimal denials is to onboard a knowledgeable billing team with experience in your medical specialty. But we all know that adding to the payroll with more billing help or taking time out of already busy schedules to offer more training is easier said than done.  

Thankfully, you can outsource your claim processing to an electronic clearinghouse like Apex EDI. Let your clearinghouse partner keep up with ever-changing payer requirements and get help checking claims for errors. A clearinghouse like Apex EDI, can integrate with the practice management solutions you are already using and save you time and money. Plus, with digital insurance billing, you could see yourself getting paid 5-12 days sooner.  

3. Have a Claim Strategy 

Okay, so whether you’ve assembled your current billing team, onboarded new employees, or partnered with a clearinghouse, you’ve got your A-team. Now, it’s time to make sure your claim processes are executed effectively. We recommend putting together clear operating procedures for your insurance billing and making sure those who need to be are educated.  

To create this plan, walk yourself through the lifecycle of claim, starting with patient intake and making copies of the insurance card. Lay out what needs to happen at every stage to make sure your claims are as foolproof as possible. This should include best practices for your providers, so they know what information they need to be documenting to avoid coding errors and prevent future audits. Also, make sure you understand the payer enrollment process, so you can set strong foundations.  

I strongly recommend that all medical and dental providers and billing services consider using Apex EDI as an effective tool to reduce administration costs and lower their account receivable balances.

Terrilynn Nicklin, Healthcare System Services, Inc.

Once claims have been drafted and submitted, create a follow-up plan. Don’t settle for leaving revenue on the table. Make sure you’re following up with denied or rejected claims, getting them revised and resubmitted as soon as possible. Also make sure you’re following up with payments from payers to make sure they are received.  

Don’t leave revenue on the table. Put together an end-to-end strategy to help maximize your claim management. 

4. Manage All Your Information 

Incorrect or incomplete information can drag submitted claims for much longer than necessary. Ensuring that you have the correct information upfront and double-checking for errors can save you from frustrations down the alley. 

An electronic clearinghouse has the latest software to help with patient records and management right from when they set foot into your organization to the time they check out. With this information, there’s enough proof to back up your claims. 

Final Thoughts 

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 at a lower cost. 

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 schedule a demo today.  

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Apex EDI, Inc.
556 E Technology Ave
Orem, Utah 84097
Support: (800) 840-9152
Sales: (801) 383-0388
Fax #: (801) 642-0333
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