Medical Claim Submission Process

Experience Shorter Processing Time and Faster Collections with Our Skilled Experts

Your healthcare practice needs dedicated experts and an integrated clearinghouse to submit accurate claims and relieve you from repetitive tasks and administrative burdens.
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Empowering Practices with Expedited Reimbursements

Reduced Denials
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Claims Processed
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First-Pass Rate
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Claim Submission Process Headaches You Want to Avoid

Navigating Healthcare Compliance Challenges

Compliance challenges in the healthcare industry can make or break the deal. Non-compliance penalties are quite common and lead to huge financial losses. Navigating these challenges is complex because of the ever-changing rules and regulatory policies.

Delayed Communication

Instant accidents can lead to severe consequences because of multiple reasons, especially delayed communication. You need to ensure an upfront meeting with the insurance company as well as the patient to keep the processes smooth while avoiding errors and delays.

Rising Claims Denials

Healthcare organizations have faced a huge rise in claims denials to an average of 11% and 20% for hospitals. A denied claim means it will either remain unpaid or increase your re-submission cost while decreasing your overall reimbursement ratio.

Claim Rejections and Denials

There are multiple reasons behind denials and each one needs stringent concentration for re-submission. According to a survey approx. 65% of denied claims are not appealed which is alarming. Providers need to work with expert billers and coders to enhance their first-pass rate.

High Costs and Short Claim Resolving Time

Delayed submission impacts your billing process resulting in high costs and prolonged resolving time, negatively affecting the patient experience. These delays are one of the top problems in billing and occur due to improper or wrong coding, no communication, etc.

Improper Coding

Improper and non-compliant coding is among the top claim submission challenges faced by providers. If the diagnostic, prescription, and treatment procedures do not follow ICD-10, CPT, and HCPCS coding guidelines they result in rejected or denied claims.

Proactively Mitigating Denial Management to Enhance First Pass Rate

Claim processing is either done manually or using automation. Both processes have their pros and cons but manual submission is more prone to errors because of its tedious and repetitive work nature. Automation requires a trained human touch for an accurate claims billing process. At Logic BPO we use both AI and expert professionals to overcome claims processing hurdles. 

We keep a balance between our digital and human resources to utilize each one as and when needed. Our denial management specialists manage the denials using our integrated claims scrubber software that uses automation.

Claim Edits in Medical Billing

Claims are reviewed and edited in the PMS where they are prepared to be sent to the integrated EHR for further processing and edits.

Clearinghouse Edits in Medical Billing

We make further clearinghouse edits using our experts and digital resources. These two combined result in faster and error-free submissions.

Claims Scrubbing Edits

Integrated claims scrubber Software uses automation to scan and identify the errors making accurate bill scrubber edits.

Payer Rejections

Once the edited and scrubbed claims reach the payer we check its status and communicate the updated information with them according to the current status of the claim.

Medical Claims Solution Specifically Designed with Your Practice Scalability in Mind

Our team is well-trained to submit clean claims faster while increasing accuracy, decreasing manual burden, and reducing costs. Get in Touch with us today and submit accurate claims tomorrow.

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Decipher Confusing Claim Challenges with Logic BPO

Regulatory Compliance and Risk Mitigation

The healthcare industry strictly stands on its compliance and regulatory policies from HIPAA to PHI and more. Compliance with these guidelines can be complex but is crucial to your steady and upward financial performance. Claim processing is strictly dependent on the compliance of HIPAA, ICD-10, CPT, and HCPCS policies to mitigate risks and avoid penalties. Our certified billers and coders ensure 100% compliance to
  • Improve first-pass resolution rate
  • Ensure adherence to regulatory policies
  • Enhance data security
  • Protect patient privacy

Reduced Claims Leakage

The ratio of payment collection directly depends upon the ratio of claims leakage. More the leakage, the lower the revenue collection ratio. Our expert managers make sure the claims are submitted faster and with a reduced leakage ratio to expedite the reimbursement process. We
  • Stay updated on payer policies
  • Capture and use accurate data
  • Thoroughly track your claim status
  • Integrate systems and processes
  • Manage denials
  • Stay strictly compliant with the latest submission updates

Integrated Automation

The manual submission process is prone to errors and mistakes therefore, leveraging technology and automation using machine learning, Artificial Intelligence (AI), & Natural language Processing (NLP) is important. Integrated automation systems at Logic BPO use EDI Standard Support & Compliance, EDI Data Mapping and Transformation, EDI Reporting and Scalability, and EDI Code Healthcare Maintenance to help you
  • Enhance overall efficiency
  • Reduce repetitive task errors
  • Streamline claims processes
  • Validate claims
  • Generate detailed reports for all purposes
  • Manage workflows from a user-friendly interface
  • Automated scrubbing and checking for regulatory compliance

Tools, Data, and Insights

At Logic BPO we make sure to improve each step of the claims billing process with the help of the latest tools, automated technology, and clear insights. Your practice needs a successful claims submission process and for this, a comprehensive end-to-end solution is supported by our dedicated team managers who provide
  • Unlimited Support
  • Dedicated account manager
  • API and HL7 easy-to-use Interface
  • Practice performance analytics
  • Thorough outreach and surveys
  • Practice audit and reporting

Mutually Beneficial Partnership Committed to Delivering Success