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Claims Submissions

Technology-Powered Clean Claim Lifecycle

By January 8, 2024January 23rd, 2024No Comments

Lifecycle of a Clean Claim

The fight against an increasing rate of claim denials persists: Medicare Advantage denials went up by 56%, and commercial denials jumped 20% this year.

Stats like these can make boosting your organization’s clean claim rate seem impossible, but it’s not—the right technology can support your revenue cycle every step of the way.

Pre-Service Preparation

Key Tasks: Verify patient eligibility, obtain pre-authorizations, and collect accurate demographic data
Tech Benefits: Real-time eligibility checks and coverage discovery for uninsured patients

At the Front Desk

Key Tasks: Confirm the accuracy of previously collected patient information and capture any missing data
Tech Benefits: Real-time data verification to reduce the administrative burden on staff and decrease the likelihood of data entry errors

After Service Occurs

Key Tasks: Document and accurately code the service so it reflects the full scope of care (and any supplies) provided
Tech Benefits: Ensures complete billing and track supply usage

Before Submission

Key Tasks: Identifying and correcting errors automatically
Tech Benefits: Streamlines the process of identifying and correcting errors across a large number of claims and building pre-claim logic to scrub claims and prevent denials on the back-end

Claim Submission

Key Tasks: Submitting claims within the specified timeframe for each payer
Tech Benefits: Facilitates timely submission, tracks claim status and provides updates

Denial Management

Reality: Denials may still occur
Tech Benefits: Use machine learning (ML) from historical data to map the most appropriate
Responses to denials, resulting in quick, one-touch fixes

Promoting Clean Claims With the Right Technology

Want to dive deeper into how technology can help at every stage of the claim lifecycle? Check out our in-depth explanation.

If you’re curious about how end-to-end RCM services could help your organization, let’s chat.