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We Provide End-to-End Claim Submission Service With First-Pass Focus

We deliver end-to-end claim submission services by preparing clean claims, validating payer requirements, submitting through the clearinghouse, and monitoring status until resolution

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Lower Days in AR

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Faster Payments

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Complete Follow-Up Coverage

We Provide Claim Submission Services Built for Clean Claims

We provide claim submission services focused on getting claims accepted the first time instead of bounced back for corrections. Our approach targets the most common breakdowns in the billing process that lead to rejections, denials, and delayed payments.

From verifying claim accuracy to aligning submissions with payer requirements, we help practices move claims through the revenue cycle smoothly and with fewer interruptions.

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Our Claim Submission Service Coverage

Our claim submission services guide each claim through its complete journey, from the moment a patient walks in to the final payment posting. We anchor this process in accuracy, compliance, and alignment with each payer's unique requirements.

Patient Demographics & Insurance Data Capture

We gather and validate essential patient details, insurance coverage, and identifying information right at intake.

Eligibility & Benefits Verification

Coverage status, plan details, and benefit information are verified beforehand.

Medical Coding Review & Charge Entry

Submitted charges are reviewed for coding accuracy. Upon reviewing, entry is done based on documented services and payer requirements.

Claim Scrubbing & Pre-Submission Validation

Claims are scrubbed for coding edits, modifier accuracy, and payer rules.

Electronic Claim Submission (Clearinghouse + Payer Routing)

Claims are submitted electronically through clearinghouse systems and routed to the appropriate payers.

Rejection Monitoring & Rapid Corrections

Clearinghouse and payer responses are monitored daily, with corrections made promptly.

Claims Follow-Up & Payer Status Tracking

We track claim status with payers, monitor processing timelines, and follow up as needed until resolution.

Payment Posting & Claim Reconciliation

Payments are posted accurately using ERA files, and claim balances are reconciled to maintain clear AR visibility.

How Our Medical Claims Submission Process Works

Our claim submission services guide each claim through its complete journey, from the moment a patient walks in to the final payment posting. We anchor this process in accuracy, compliance, and alignment with each payer's unique requirements.

Step 01
Eligibility & Benefits Verification

Eligibility & Benefits Verification

We confirm active coverage, payer responsibility, and benefit details before submitting claims.

Step 02
Claim Scrubbing & Coding Accuracy Checks

Claim Scrubbing & Coding Accuracy Checks

Each claim is reviewed for CPT, ICD-10, and HCPCS accuracy.

Step 03
Payer-Specific Compliance Edits

Payer-Specific Compliance Edits

Claims are checked against Medicare rules and commercial payer policies.

Step 04
Clearinghouse EDI Submissions & Payer Routing

Clearinghouse EDI Submissions & Payer Routing

Clean claims are submitted through clearinghouse EDI using 837P and 837I formats.

Step 05
Real-Time Rejection Monitoring & Corrections

Real-Time Rejection Monitoring & Corrections

Clearinghouse and payer rejections are monitored daily. Errors are corrected and resubmitted the same day to prevent payment delays.

Step 06
Payment Tracking, Posting & Reconciliation

Payment Tracking, Posting & Reconciliation

ERA files and payer responses are tracked through posting and reconciliation.

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What We Verify Before Every Submission

Every claim undergoes a thorough validation to ensure it's accurate, complete, and payer-ready.

Patient Information

Verify demographics, insurance coverage, and eligibility.

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Diagnosis and Procedure Codes

Confirm accurate ICD, CPT, and HCPCS coding.

Modifiers and POS

Validate correct modifiers and place-of-service codes.

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Provider NPIs

Check referring and rendering provider NPI details.

Medical Necessity

Ensure alignment with payer-specific medical necessity guidelines.

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Claim Formatting

Ensure claims meet clearinghouse and payer submission standards.

Why Medical Claims Get Rejected (And How We Prevent It)

We Provide Claim Submission Services Built for Clean Claims

Coding Errors & Missing Modifiers

We review CPT, ICD-10, and modifiers to ensure services are coded correctly before submission.

Faster scheduling

With approvals secured early, appointments are booked with confidence. There is no waiting on last minute payer decisions or rescheduling due to incomplete approvals.

Eligibility & Authorization Gaps

We verify active coverage, required authorizations, and referral details upfront.

Missing Documentation & Medical Necessity Issues

We confirm clinical documentation supports the services billed.

Timely Filing Limit Violations

Claims and corrections are submitted within payer filing deadlines.

Duplicate, Incomplete, or COB Errors

We identify duplicates, missing data, and coordination of benefits issues before submission.

Why Our Claim Submission Model Outperforms Others

Factor
Staffing benefits
Payer rule expertise
Rejection handling
Technology costs
Scalability
Performance accountability
In-House Billing
Vulnerable to turnover
Limited bandwidth
Often delayed
Internal overhead
Limited
Internal burden
Outsourced to OneMed
Dedicated, consistent team
Multi-payer specialization
Same-day correction cycles
Included
Easily scalable
Measured, reported outcomes

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Why Outsource Your Claims Submission to Us

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Higher Clean Claim Rates From Day One

Claims are reviewed and validated before submission to reduce rejections.
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Faster Payments With Proactive Error Resolution

Issues are identified early and corrected quickly to keep claims moving.
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Lower Operating Costs Than In-House Billing Teams

Outsourcing reduces staffing, training, and system overhead.
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Built-In Compliance and Payer Rule Expertise

Claims are aligned with Medicare and commercial payer requirements.
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Scalability During Volume Spikes and Growth

Support adjusts easily as claim volumes increase.
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Complete Visibility Without the Administrative Burden

Claim status and outcomes are tracked without added workload for your team.
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Claims Performance Results Our Clients Typically See

  • Higher first-pass acceptance rates
  • Significant reduction in preventable denials
  • Faster payment turnaround from major payers
  • Reduced AR days and improved cash flow visibility

Claim Submission Services by Medical Specialty

Primary Care Claims Processing

We manage high-volume claims across complex payer mixes with consistent accuracy.

Urgent Care Claims Submission

We address fast-paced coding, eligibility challenges, and same-day billing demands.

Behavioral Health Billing

Authorization tracking, time-based coding, and documentation-heavy claims are handled carefully.

Surgical & Specialty Practices

We manage bundling rules, global periods, and modifier-driven reimbursement.

DME & Ancillary Services

Medical necessity, proof of delivery, and frequency limits are verified before submission.

Telehealth & Virtual Care Claims

We monitor and adapt to evolving telehealth policies and billing rules.

Physical Therapy & Rehabilitation Billing

Visit limits, authorization tracking, and modifier usage are monitored regularly.

Medical Imaging & Diagnostic Services

Prior authorizations, bundling edits, and payer coverage rules are addressed upfront.

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Compliance, Security & Billing Standards We Follow

  • HIPAA-compliant workflows and access controls
  • Audit-ready documentation and reporting
  • Alignment with payer documentation standards
  • Secure data handling and transmission protocols

Testimonial

“Since switching to OneMed, our claim denial rate dropped from 22% to 6%, and we are getting paid in half the time. Our cash flow has never been better.”
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Practice Manager
Neurology Group

Frequently Asked Questions

Do you support institutional and professional claims?   

Yes, we submit both CMS-1500 and UB-04 forms depending on your billing setup.

Can you submit to both government and commercial payers?   

Absolutely. We handle Medicare, Medicaid, Tricare, VA, and all major commercial plans.

How fast do you submit claims?   

Most are submitted the same or next business day, depending on charge receipt time.

Do you flag issues before submitting?   

Yes. We run pre-submission QA and will notify your team if a claim is incomplete or risky.

Are your workflows HIPAA compliant?   

Yes. All team members undergo regular HIPAA training and data is exchanged securely.

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