An efficient healthcare service needs an intelligent and clever claims adjudication process. It is always advisable to take a plausible path to ensure clients, that their claims will get first pass-rate on one stroke of submission.

The impressive achievement of first submission pass rate recommends uncompromising approach towards maintaining the highest levels of quality and dedication in their billing and claim submission efforts. An immense experience in working with the ‘payer side’ also gives an extra edge in understanding what insurance companies look for in submitted claims— and how a claim should be submitted properly— to meet with instant approval.

Clients’ doing the rounds for denied and rejected claims makes them exasperated. To reduce their administrative burdens and to take care of medical practices, medical billing outsourcing company plays a vital role in getting claims approved at first submission.

To get out of the intermittent process, claims adjudication process should be made smoother and faster with specialized skill-set of personnel. Many a times, it has been observed that, minor data entry errors—misspelled names, insurance ID number, or other improper submission of documents—leads to the rejection of claims.

Let’s look on the strides, a claim adjudication personnel takes to make first submission pass rate

♦ Submitting correct paper work within deadlines will ease the flow. On this note, a regular follow-up is obligatory to ensure the smoothness of the service.

♦ It is required to keep a digital paper trail as a reference when dealing with insurer. A proper correspondence between claims adjudication personnel insurer, and doctor is essential via e-mail.

♦ Pre-audit claim fields automatically for potential errors before submission to a payer

♦ Identify claim issues at the first place and provide online claim resolution before processing by a payer. Hereby, assuring the timeline will be beneficial for all the parties involved

To make first claim submission pass rate a success, an experts should have to look for the entire details meticulously. This will definitely help to prevent from the data-entry errors. When re-submission of claims takes place, it shows lack of persistency.