Claims checking and error resolution
Claims checking and error resolution
Duplicate Claim Detection
Coding Accuracy Checks
Automated Claim Scrubbing
Error Resolution
Ensure every claim is accurate and reimbursement-ready with our Claims Checking & Error Resolution service. At Emerger RCM, we catch claim errors early, resolve issues proactively, and reduce denials improving cash flow and minimizing administrative burden.
Claims Checking
Our claims checking workflow ensures each claim is systematically reviewed before submission. We validate patient demographics, insurance eligibility, clinical coding (CPT/ICD), and payer-specific requirements. Using both automated claim scrubbers and expert auditors, we detect common errors such as missing modifiers, invalid codes, or eligibility lapses.
Corrections are applied in real time, and every claim is resubmitted only after passing a multi-point QC process. By reducing avoidable denials, this approach accelerates first-pass claim acceptance and optimizes revenue performance.
Error Resolution
When errors are found during checks or after payer rejection, our dedicated resolution team intervenes immediately. We categorize errors such as coding discrepancies, incomplete documentation, or filing-limit issues and perform root-cause analysis. Claims are corrected, recreated, and resubmitted within payer timelines, with full documentation of changes. Our team follows up actively, ensuring responses to payer requests, appeals for minor errors, or comprehensive resubmission. This proactive error management safeguards revenue and reduces backlogs.
Contact us today to learn more about our team
We would be happy to answer any questions you may have or provide you with additional information about our services.
Automated Claim Scrubbing
Real-time error detection using advanced software to flag missing codes, modifiers, or duplicate entries.
Demographic & Eligibility Verification
Checks ensure patient info and insurance coverage are current for each claim.
Coding Accuracy Checks
Validates CPT/ICD code combinations and modifiers to prevent coding denials.
Payer Rule Compliance
Ensures claims meet insurer-specific formatting and documentation requirements.
Duplicate Claim Detection
Prevents double-billing by identifying claims already submitted or paid CMSPractice.
Exception Routing & Manual Review
Complex cases are flagged and escalated for human review with audit trail documentation.
We don’t just fix errors we identify why they happen. For recurring mistakes like inaccurate coding or missing documentation we perform in-depth root‑cause analysis. Our findings inform targeted feedback to your clinical and billing teams, reducing repeat errors.
This learning loop helps refine workflows, update staff training, and adjust system settings. Over time, practices see a noticeable drop in claim corrections and denials. This continuous improvement model empowers your organization to become more self-sufficient and billing-savvy.
When a claim is rejected or denied, time is of the essence. Our team immediately identifies whether it requires simple resubmission or formal appeal especially for minor clerical errors under Medicare guidelines. We prepare corrected claims, ensure they meet payer-specific rules, and re-submit within mandated timeframes.
For more complex denials, our appeal specialists gather supporting documentation and file timely appeals. Regular status tracking and follow-up communications help ensure denials are reversed quickly, minimizing revenue loss.
Every insurer has unique claim requirements. We utilize a dynamic rule engine customized for each payer, continuously updated with the latest policy changes. It checks claim format, allowed modifiers, coverage criteria, and timely filing windows.
The system flags potential deviations before submission, auto-corrects data where possible, and routes exceptions for manual review. This ensures each claim aligns precisely with payer expectations boosting acceptance rates and simplifying remittance processes.
You get more than just fixes you get insights. Our analytics dashboard consolidates details by denial reason, payer, provider, and service type. You can easily track trends like spikes in incorrect modifiers or documentation gaps for specific CPT codes.
Managers receive monthly reports with actionable recommendations such as focused coding training or form updates. This data-driven approach not only accelerates revenue recovery but also drives strategic enhancements in your billing process.
Staying current is critical. We offer ongoing training sessions for coding and billing staff, focusing on emerging payer rules, regulatory changes, and common error trends. Regular refreshers on Medicare appeal processes, insurer-specific guidelines, and system updates ensure your team maintains high claim quality.
We also circulate monthly compliance bulletins highlighting key changes preventing errors before they happen and maintaining audit-readiness across your practice.
