Claim Submission Services

After you complete a patient encounter, finish your documentation and coding inputs, and sign-off to close your charge notes for billing, Avosina deep-dives into your notes, reviews and corrects all elements, and creates a superbill from which medical billers can manually or electronically prepare a claim for submission to payers. The claims are formatted precisely for different federal and commercial payers on various forms, each appropriate for a different type of charge or payer; such forms include the CMS-1500 form, the UB-04 form, etc.

Upon preparing the claim, the medical billing team will initiate the claim submission process.  First the claim will be transmitted to the provider’s contracted Clearinghouse, which ensures that the claim has all of the appropriate data and formatting necessary for claim submissions to payers. If an error is found, the claim will be rejected, and the biller will have to resubmit the claim. Once approved, the claim gets transmitted to the payer.

When the payer receives the claim, the settlement process initiates, wherein the payer assesses the claim and makes a decision to accept the claim totally, deny the claim totally, requested additional medical records documentation to support the claim, or provide partial payment of the claim. An electronic remittance form will be sent by the payer to the provider’s practice detailing services paid, services denied, and what additional documentation may be needed for reimbursement. 

Avosina’s medical billing claim submission process

Our charge entry transactions remain consistent throughout:

• Analyze all charge entries (charge tickets, superbills, imported charges from EHR systems, etc.).
• Review and establish charge and medical coding accuracy regarding CPT, ICD-10, POS, DOS, admission date, billing provider, referring provider, units, and modifiers.
• Cross-check with automated tools and manual escalation teams for additional verification of accuracy.
• Dedicated claim submissions team ensures rapid, accurate, focused delivery of claims, transmittal and double-checked through the Clearinghouse to the payer.
• Harness in-house, proprietary tools to display real-time claim status to you.

Value we add to you with Avosina’s Medical Billing Claim Submission Services

• Improve accuracy and rapidity of claim submissions
• Discover and rectify lost charges
• Prevent delays in obtaining AR
• Analysis of charge entry processes to prevent revenue loss
• Maximize revenue generation and identify missed revenue opportunities
• Discern and correct compliance issues related to overcoding and overcharging
• Establish and maximize appropriate reimbursements
• Real-time, transparent reporting and communication channels
• Enhance workflow productivity and coding accuracy
• Timely filing of claims and benchmarking of fee schedules
• Ascertain historic denial patterns to mitigate future denials