Rejected claims
Rejections differ from denials and often need correction before processing. We review submission errors, required fields, patient and provider details, and claim formatting before resubmission.
The bigger picture
A stronger revenue cycle starts with the details.
Submitting a claim is only one step in reimbursement. We review available claim information, submit through your established billing workflow, address rejected claims, and monitor outstanding claims throughout the billing cycle.
Consistent review, submission, monitoring, and follow-up help keep claims moving toward an appropriate resolution.
Built around your needs
What’s included
- Claim preparation and review
- Primary and secondary claim submission
- Rejected claim management
- Corrected claims and resubmissions
- Claim status monitoring and payer follow-up
- Missing information and documentation follow-up
- Timely filing monitoring
- Claim documentation and outstanding claim reporting
We agree on the exact scope, responsibilities, and reporting with your practice before work begins.
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Preparation and review
We review the information needed to prepare complete, accurate claims.
- Patient demographics, insurance, and subscriber details
- Provider information, date and place of service
- Diagnosis and procedure information
- Units and modifiers
- Authorization and other required billing information
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Corrections, rejections, and secondary claims
Corrected claims
We support payer-specific corrections for billing information, codes, modifiers, insurance updates, units, and other claim details.
Secondary claims
After primary processing, we review primary payment information and patient responsibility, prepare secondary claims, and follow up on outstanding secondary balances.
Timely filing
We prioritize attention by filing deadline, service date, status, payer, balance, and processing stage.
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Claims tracking and reporting
Reporting can show submitted, pending, rejected, corrected, resubmitted, denied, paid, and outstanding claims, including accounts awaiting information or payer action.
- Aging and high-value claims
- Timely filing concerns
- Claim receipt, processing, and payment status
- Documentation requests and reprocessing needs
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Connected to your A/R workflow
Service → Charge entry → Claim preparation → Submission → Processing → Payment → A/R follow-up. When an issue occurs, we identify the appropriate next step.
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Support for different practices
Workflows can be adapted to the practice’s services, payer mix, and operational needs.
- Mental and behavioral health and psychiatry
- Physical therapy
- Pediatrics and internal medicine
- Outpatient practices
- Individual providers and group practices
From review to follow-up
A clear process. At every step.
Review
Identify potential issues in available claim information before submission.
Submit
Submit through your practice’s established billing process and applicable payer requirements.
Monitor
Track submitted claims to determine their current status.
Identify issues
Review rejected, delayed, or otherwise problematic claims to determine the cause.
Correct
Correct claim information when appropriate and supported by available information.
Resubmit
Resubmit corrected or rejected claims according to payer requirements.
Follow up
Contact payers on outstanding claims and determine the next appropriate action.
Report
Include claim activity and unresolved issues in billing and A/R reporting.
Why it matters
Better support for the work behind the care.
- Reduce avoidable rejections and rework
- Improve submission timeliness and claim visibility
- Reduce administrative workload
- Support cash flow and prevent unnecessary claim aging
A little more clarity
Your questions, answered.
What is the difference between a rejection and a denial?
A rejected claim often needs correction before it can be processed. A denied claim has not been paid by the payer and requires review to determine whether correction, an appeal, additional information, or another action is appropriate.
Do you support secondary claims?
Yes. After primary processing, we can review primary payment information and patient responsibility, prepare and submit secondary claims, and follow up on outstanding secondary balances.
What happens after a claim is submitted?
We monitor claim status, investigate delays or requests for information, document payer responses, and determine the next action. Claim activity and unresolved issues can be included in reporting.