Revenue Cycle Management Services
Coordinated support across the administrative steps of the billing cycle, from intake details to follow-up.
Service
Claims Management Services
Organised tracking and follow-up of submitted claims, with clear notes on what is waiting and why.
Overview
About Claims Management Services
A claim is not finished when it is submitted. It may be accepted, rejected for a correctable reason, pended for more information or paid in part. Without someone tracking it, a claim can sit in one of those states for weeks.
Claims management support gives every open claim a status, a next step and a person responsible for it. We keep the trail of what was done, so your team does not have to reconstruct it later.
What the work can include
- Preparing claims and checking them for missing or inconsistent information
- Submitting claims and confirming that the payer received them
- Tracking each claim's status through to payment or resolution
- Correcting and resubmitting claims returned for a fixable reason
- Reporting on aging claims and items waiting on your practice
How it fits with your team
We work through your claims on a regular schedule and tell you what is waiting on a decision, a document or a payer response, so open items do not depend on someone remembering them.
Common challenges
Where administrative work tends to get stuck
Practices come to us when routine business tasks start taking more time and attention than they should.
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Work without a clear owner
Tasks are shared between people who are also busy with patients, so follow-up is easy to miss.
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Inconsistent processes
Each person does the same task a little differently, which makes errors harder to spot.
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Scattered documentation
Information sits in email, paper files and separate systems, and is slow to find when it is needed.
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Limited visibility
It is hard to see what is in progress, what is waiting and what needs a decision.
What the support covers
How we support your team with Claims Management Services
The exact scope is agreed with you, and it depends on your practice and your systems. In general, our support covers these areas.
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Workflow review
We look at how the work is handled today and agree how it should be handled from here.
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Day-to-day handling
We carry out the agreed tasks on a regular routine, following your instructions and preferences.
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Follow-up on open items
We keep track of work that is waiting on someone, and raise it with you when it needs attention.
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Documentation
We keep notes and records of the work in a consistent format that your team can review.
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Regular updates
We keep you informed about progress and anything that needs your decision.
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Ongoing adjustment
As your needs change, we review the arrangement with you and adjust it.
How it works
How Claims Management Services support is set up
A simple, four-step approach that keeps you informed at each stage.
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01
Review
We learn how your practice handles Claims Management Services today: your people, systems, payers and priorities.
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02
Configure
We agree what we will take on, how we will work with your systems, and how we will communicate.
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03
Manage
Our team carries out the agreed work on a regular routine and keeps records of what was done.
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04
Monitor
We review progress with you, share what we see and adjust the approach when something changes.
Benefits
What working with us is designed to give you
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Workflow clarity
Everyone knows what is being done, by whom and what comes next.
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Administrative consistency
Work follows defined steps, so it looks the same from one week to the next.
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Better documentation
Records are kept in an organised way that is easy to check and hand over.
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Visibility
Regular updates show you where things stand without you having to ask.
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Operational support
A dedicated team shares the routine workload with your own staff.
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Flexibility
The arrangement can be reviewed and changed as your practice changes.
Who it supports
Support for healthcare businesses
Our Claims Management Services support is designed for the people who run healthcare organizations: physicians, medical practices, clinics and healthcare groups.
Specialties we support
Explore the medical specialties this service applies to.
Related services
Other ways we can help
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Credentialing Support
Help with the paperwork and follow-up involved in provider credentialing.
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Medical Coding Services
Coding and documentation support that keeps claims consistent with the record they are based on.
FAQ
Questions about Claims Management Services
Answers to questions we are often asked about this service.
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In general, a rejection is a claim returned before it is processed, often because of a data problem that can be corrected and resent. A denial is a decision by the payer not to pay all or part of a processed claim. We follow up on both.
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We keep a status and next step for each open claim and share regular summaries in a format agreed with you.
Talk to us about Claims Management Services
Tell us what your practice needs and we will explain how our support could work.
Please do not include patient information.