Claims Submission & Tracking
Submit clean claims on the first pass with built-in claim scrubbing, automatic coding validation, and real-time status tracking. Batch submission, payer-specific rules, and clearinghouse integration ensure maximum reimbursement.
Works with
- Medical Coding ToolsCPT and ICD-10 code lookup, validation, and coding review workflows for billing accuracy.
- Eligibility VerificationReal-time and batch insurance eligibility checks to reduce claim rejections.
- Denial Management & AppealsIdentify, work, and appeal denied claims with analytics to prevent future denials.
A claim is the practice asking a payer for money, and the payer looks for any reason to say no. Claims Submission & Tracking is the part of the platform that builds the claim from the charge, checks it against the rules the payer will apply, sends it through the clearinghouse, and then keeps watching it until it is paid, denied, or stuck.
The scrubber runs before anything leaves the building. It checks that the diagnosis supports the procedure, that modifiers are present where a payer expects them, that the rendering provider is enrolled with that payer, and that the subscriber information matches what eligibility returned. A claim that fails a check stays in the practice’s queue with the reason in plain English, so the fix happens once, before submission, instead of three weeks later as a rejection.
After submission, every status change the clearinghouse reports is written back to the claim with a timestamp. Clearinghouse rejection codes are translated into readable sentences, so a front-desk user can see “the subscriber ID does not match the payer’s records” instead of a token they have to look up.
Key Benefits
Higher clean-claim rates
Automated claim scrubbing
Real-time status tracking
Batch submission capability
What the claims module does
Pre-submission scrubbing
Payer-specific edits run on every claim before it is batched. Failed edits block the claim and explain why; passed claims move straight to the batch.
Batch submission through the clearinghouse
Clean claims are grouped and sent electronically. Each claim keeps its own clearinghouse identifier, so a batch of 300 is still 300 individually traceable claims.
Rejection reasons in plain English
Clearinghouse reject tokens are mapped to readable explanations and the field that needs attention, so corrections do not require a coder to decode them.
Claim attachments (PWK)
When a payer needs supporting documentation, a PDF can be attached to a single claim and sent with it. The attachment is validated as a real PDF, tied to the charge so a retry never orphans it, and only sent after a human confirms the payer accepts electronic attachments.
Status history and audit trail
Every submission, acceptance, rejection, and resubmission is logged with who did it and when. Nothing about a claim’s life is reconstructed from memory.
Resubmission without re-entry
A corrected claim reuses the original charge and coding, carrying the payer’s original claim number forward where the payer requires it.
How It Works
Charge becomes claim
Coded charges from the encounter or superbill are assembled into a claim with the right billing provider, rendering provider, and place of service for that payer.
Scrub
The claim is checked against payer rules and enrollment status. Anything that would be rejected is held with a readable reason and a link to the field to fix.
Submit and track
Clean claims go out in a batch. Acknowledgements, rejections, and acceptance from the clearinghouse post back to the claim automatically.
Work the exceptions
Rejected and stalled claims surface in a queue sorted by age and dollars, so the oldest, largest problems are worked first and timely-filing limits are not missed.
Frequently asked questions
What is claim scrubbing and why does it matter?
Can I attach documentation to a claim?
How do I know why a claim was rejected?
Ready to transform your claims submission & tracking?
Built for healthcare practices that are done fighting their billing software.