Claim Submission Services

Claim submission is the process of transmitting medical claims to insurance payers for reimbursement after services are provided. In simple terms, it is the step where a healthcare provider sends service details to an insurance company to receive payment. MZ Medical Billing submits professional and institutional claims, including CMS-1500 and UB-04, through HIPAA-compliant clearinghouses, following payer-specific formatting, coding, and filing rules to reduce rejections and processing delays.

Each claim is reviewed for coding accuracy, modifier use, provider enrollment status, patient eligibility, and payer policy requirements before submission. Claims are filed with Medicare, Medicaid, and commercial insurance plans in accordance with timely filing limits. Acceptance reports are monitored to confirm successful transmission, and rejected or pended claims are corrected and resubmitted based on payer feedback to keep reimbursement moving through the revenue cycle.

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98%
Claim Approval Rate

97%
First pass Ratio

<30
Days in AR

96%
Collection Ratio

Why You Need Outsourced Claim Submissions & Tracking

Claim submission and tracking require consistent oversight of payer rules, filing deadlines, and claim responses. Errors at any stage, submission, acceptance, rejection, or follow-up, can lead to delayed payments, denials, or missed reimbursement opportunities. Without structured tracking, claims may remain unresolved in accounts receivable.

MZ Medical Billing manages claim submissions and tracking as part of the full revenue cycle, monitoring each claim from initial transmission through final payment or appeal. This approach reduces preventable errors, limits missed payer responses, and improves visibility into outstanding claims.

You May Need Claim Submission Services If

Insurance payments are delayed or inconsistent
Delays often occur when claims are rejected, pended, or not followed up within payer timelines.
There is no clear view of claim status
Without acceptance and rejection monitoring, it is difficult to confirm whether claims reached the payer.
Claims are rejected due to coding or data errors
Errors in CPT, ICD-10, modifiers, or patient details commonly result in rejections before adjudication.
Accounts receivable continues to grow
Aging AR frequently reflects unresolved claims or missed follow-up actions.
Follow-ups are reactive instead of scheduled
Claims require timely action based on payer response cycles, not random checks.
Claims are handled manually or across disconnected systems
Manual tracking increases the risk of missed rejections and filing deadlines.
Payment variations across payers are unclear
Underpayments or partial payments may go unnoticed without structured review.
Staff time is consumed by billing administration
Clinical and front-office staff are often pulled into billing tasks outside their core role.

How MZ Medical Billing Improves Claim Outcomes

MZ Medical Billing applies payer-specific claim review, electronic submission through HIPAA-compliant clearinghouses, and structured tracking of acceptance reports, rejections, pending claims, and payment postings. Rejected claims are corrected based on payer feedback, and unresolved claims are followed until resolution or appeal.

This process strengthens control over claim movement, reduces avoidable revenue loss, and provides clearer insight into the status of outstanding reimbursements—without increasing internal workload.

What MZ Medical Billing Tracks for Every Claim

Claim acceptance and transmission reports
Confirms whether claims were successfully received by the payer or rejected at the clearinghouse level.
Rejected claims and correction reasons
Identifies data, coding, or formatting issues and applies payer-specific corrections before resubmission.
Pending and pended claims
Monitors claims awaiting payer review, documentation, or additional processing.
Denials and denial reasons
Reviews payer explanations to determine correction or appeal requirements.
Timely filing limits
Tracks payer deadlines to prevent claims from expiring unpaid.
Payment and underpayment status
Confirms reimbursements align with contracted or expected payer rates.
Accounts receivable aging
Reviews unpaid claims by age to prioritize follow-ups and reduce revenue backlog.
Maintains a documented record of claim actions and payer responses.

End-to-End Claims Processing and Follow-Up

MZ Medical Billing Services manages medical claims throughout the entire billing cycle, from submission to payment posting and follow-up. With more than a decade of experience applying payer rules and reimbursement standards, our team works with hospitals, physician practices, outpatient clinics, and healthcare organizations that bill commercial, Medicare, and Medicaid programs.

Our billing team includes claims processors, certified coders and billers, claims analysts, credentialing specialists, and reimbursement professionals. Based on claim type, payer requirements, and documentation quality, MZ Medical Billing processes are designed to:

Achieve up to 98% clean claim rate on eligible submissions
Maintain claim denial levels below 8%
Support average reimbursement timelines of 35–40 days, depending on payer processing cycles
Monitor net collections, with many clients maintaining net collection rates approaching 95% after claims are resolved

How Claims Are Managed

Integration with EDI, EHR, EMR, and practice management systems to reduce errors and support accurate electronic claim submission
Verification of patient demographics, insurance eligibility, and coverage details before submitting claims
Coordination of prior authorizations when required by payer policy
Real-time claim scrubbing to check procedure, diagnosis, and modifier codes for accuracy
Handling multiple billing models, including fee-for-service, telehealth, value-based, and capitated arrangements
Submission of claims using appropriate forms, including CMS-1500 and institutional claim forms
Review of CPT, ICD-10, HCPCS, revenue codes, and modifiers to reduce claim rejections
Ongoing claim follow-up, including payer communication and correction of payment adjustments
Review of explanations of benefits (EOBs) to confirm coverage, payment accuracy, and patient responsibility
Resolution of disputes and submission of appeals when reimbursement does not match payer policy
Detailed reporting on charges, payments, adjustments, deductibles, copayments, and outstanding balances
Accurate recordkeeping of claims, remittance data, and billing documentation

With this structured process, MZ Medical Billing helps providers keep claims moving, reduce preventable revenue loss, and maintain control over accounts receivable without adding administrative work to in-house staff.

How We Handle Your Medical Claims

MZ Medical Billing manages medical claims throughout the full billing cycle, from submission to payment posting and follow-up. Each claim is reviewed, coded, and submitted according to payer-specific requirements, reducing errors, minimizing rejections, and supporting timely reimbursement.

Daily Electronic Claim Submission

Claims are submitted electronically every business day through HIPAA-compliant clearinghouses. Daily submissions reduce processing delays, improve cash flow, and ensure claims reach payers according to their specific filing requirements.

Over 98% Clean Claims Rate

Using a combination of automated claim scrubbing and detailed expert review, MZ Medical Billing maintains over a 98% clean claim rate on eligible submissions. Each claim is checked for accuracy in CPT, ICD-10, HCPCS, revenue codes, modifiers, and patient information, which reduces rejections and avoids unnecessary delays in payment.

Expertise Across All Claim Types

Our team manages professional (CMS-1500) and institutional (UB-04) claims across multiple billing models, including fee-for-service, telehealth, value-based, and capitated arrangements. Each submission is verified against payer rules to ensure proper formatting, coding, and documentation.

Rejection and Denial Management

Rejected or denied claims are reviewed immediately. Our team identifies the cause—such as coding, documentation, or eligibility errors—corrects the claim, and resubmits it according to payer rules. Prompt handling reduces delays and improves revenue cycle performance.

Real-Time Claim Tracking

All claims are tracked in real time from submission to final payment posting. This provides visibility into each claim’s status, allows proactive follow-up on pending or rejected claims, and ensures that accounts receivable remains under control.

Dedicated Expert Support

Our billing specialists are available to answer questions, resolve issues, and provide guidance on claim-related matters. Hands-on support helps practices maintain accurate submissions, reduce administrative burden, and keep revenue flowing reliably.

Our Expert Claim Submission Services

MZ Medical Billing handles every step of claim submission to support healthcare providers in maintaining accurate and efficient revenue cycles. From registering patients and verifying insurance to coding, billing, and following up on claims, the team works carefully to reduce errors, improve first-pass claim approval rates, and support timely reimbursement. Each claim is submitted according to payer-specific rules for commercial, Medicare, and Medicaid programs to ensure compliance and accuracy.

Patient Registration

We collect and verify all patient information, including demographics, insurance coverage, and eligibility. Accurate registration helps prevent rejections related to eligibility, data errors, or missing information before services are provided.

Coding and Billing

Our team assigns CPT, ICD-10, HCPCS, and revenue codes accurately and follows payer-specific rules. Each claim is reviewed to be compliant, complete, and ready for electronic submission, supporting over 98% clean claim rates for eligible submissions.

Insurance Verification

We confirm active coverage for every patient, check deductibles, co-pays, and any required prior authorizations. Medicare, Medicaid, and private insurance benefits are reviewed to ensure claims are billed correctly the first time.

Claims Scrubbing

We review every claim for missing or conflicting information before submission. Automated and manual checks help catch errors, reduce front-end rejections, and improve first-pass approvals.

Claims Submission

All claims are submitted electronically through HIPAA-compliant clearinghouses. Each claim is verified for accuracy and compliance with payer-specific rules to ensure it reaches the payer correctly and on time.

AR Management

We monitor all submitted claims for delays, rejections, or missing responses. Issues are addressed promptly to prevent revenue loss and ensure accounts receivable is up to date.

Claims Follow-Up

Outstanding claims are tracked and prioritized according to age and payer response. Our team follows up on older or pending claims to help reduce collection times and improve cash flow.

Payment Posting

Insurance and patient payments are applied accurately and reconciled with explanations of benefits (EOBs). Any underpayments or discrepancies are identified and corrected to maintain accurate account balances.

We Submit Claims For All Medical Specialties

MZ Medical Billing submits claims for a wide range of medical specialties. Each claim is coded, formatted, and submitted according to payer-specific requirements, following commercial, Medicare, and Medicaid rules. Our team reviews documentation carefully to reduce errors and rejections, supporting accurate first-pass approvals. Claims are processed for both professional and institutional settings, helping providers maintain control over revenue and accounts receivable.

Applied Behavior Analysis

Behavioural Health

Pediatric

Mental Health

Physical Therapy

Occupational Therapy

Speech Therapy

Anesthesiology

Radiology

Gynecology

Ambulatory

Urgent Care

Neuorology

Orthopedics

Cardiology

Chiropractic

Opthalmology

Oncology

Dental

Gastroentrology

Our Medical Claim Submission Process

Patient Verification

Patient details, including demographics and insurance information, are collected and verified for eligibility and coverage. Accurate verification prevents errors, reduces rejections, and confirms that claims are ready for billing.

Charge Entry & Coding

Charges are entered and coded using CPT, ICD-10, and HCPCS codes. Trained coders apply payer-specific rules and check documentation to create compliant and accurate claims.

Claim Generation & Scrubbing

Claims are generated in the billing system and reviewed before submission. Automated and manual checks identify coding errors, missing information, or formatting issues to produce clean claims ready for electronic submission.

Claim Submission to Payers

Clean claims are submitted electronically through HIPAA-compliant clearinghouses to the primary or secondary payer. This structured submission process supports faster processing, reduces errors, and improves first-pass approval rates.

Claim Tracking

Claims are tracked in real time from submission to payment posting. Regular monitoring identifies delays or issues so that claims do not remain unresolved, keeping accounts receivable current.

Rejections and Resubmissions

Rejected or denied claims are reviewed immediately. The cause, such as coding errors, missing documentation, or eligibility issues, is corrected, and the claim is resubmitted following payer rules. Prompt handling reduces delays and maximizes reimbursement.

Are Your Claims Getting Lost in the System?

MZ Medical Billing manages every claim through the full billing cycle to prevent delays or lost submissions. Claims are verified, coded, and submitted electronically through HIPAA-compliant clearinghouses. Each claim is tracked in real time, allowing the team to identify and address rejections, denials, or missing responses promptly.

This structured approach reduces errors, supports first-pass approval rates above 98%, and helps maintain timely reimbursement. By keeping accounts receivable under control, providers can focus on patient care rather than manual follow-ups or administrative tasks.

Take control of your claims today and ensure accurate submissions, consistent tracking, and faster payment cycles.

FAQS

Claim Submissions FAQS

What is a medical claim submission?

A medical claim submission is the process of sending detailed information about the healthcare services provided to a payer (insurance company, Medicare, or Medicaid) for reimbursement. This includes patient details, diagnosis codes, procedure codes, and supporting documentation.

Why is accurate claim submission important?

Accurate submissions reduce rejections and denials, improve first-pass approval rates, and help providers maintain steady revenue. Even small errors in coding, patient information, or payer requirements can delay payment and increase administrative workload.

What makes a claim “clean”?

A clean claim contains all necessary information, including correct CPT, ICD-10, and HCPCS codes, accurate patient and insurance details, and any required prior authorizations. Clean claims are more likely to be approved on the first submission.

How does claim scrubbing work?

Claim scrubbing is the process of reviewing each claim for errors or missing information before submission. This includes automated checks and manual review to identify coding mistakes, formatting issues, and eligibility mismatches. Scrubbing improves first-pass approvals and reduces delays.

How long does it take for claims to be processed?

Processing timelines depend on the payer, type of claim, and completeness of documentation. With structured submission and follow-up processes, many providers receive reimbursements within 35–40 days on average.

What happens if a claim is rejected or denied?

Rejected claims are reviewed immediately. Our team identifies the cause,such as coding errors, missing documentation, or eligibility issues, corrects it, and resubmits the claim. Denials that require appeal are handled according to payer guidelines to maximize reimbursement.

How can I track my submitted claims?

Claims are tracked electronically from submission to payment posting. Real-time monitoring allows the team to identify pending or rejected claims quickly, ensuring no claim is lost and accounts receivable stays current.

What types of claims can you submit?

We handle professional claims (CMS-1500), institutional claims (UB-04), telehealth, value-based billing, capitated arrangements, and specialty-specific claims across multiple disciplines including PT, OT, SLP, behavioral health, radiology, cardiology, and more.

How do you ensure compliance with payer rules?

Our team follows payer-specific rules for commercial insurance, Medicare, and Medicaid programs. Each claim is reviewed against documentation standards, coding guidelines, and submission requirements before sending, reducing errors and denials.

What is first-pass claim approval and why does it matter?

First-pass approval occurs when a claim is approved without any rejections or requests for additional information. Higher first-pass rates reduce delays, improve cash flow, and decrease the administrative effort required to manage denials.

How do you manage accounts receivable (AR) with submitted claims?

Accounts receivable is monitored continuously. Claims that are pending, delayed, or rejected are flagged for follow-up. This proactive management reduces outstanding balances, shortens collection cycles, and prevents revenue loss.

How can I verify if my claim has been submitted correctly?

Each claim submission is documented, and status is tracked in real time. Providers can receive regular reports showing submitted claims, pending or denied claims, payment details, and any adjustments applied.