Reduce Claims Processing Time

Medical claims process
Hero Images/Getty Images

Getting your medical claims out of the door and paid as soon as possible is every health care provider's primary goal as far as finance is concerned. The faster the claim goes out, the faster the money comes in. Make sure your office is equipped with the necessary software to save time and money. There are three areas that can help you reduce claims processing time.

Real-Time Benefits Verification

One of the most valuable tools for reducing claims processing time is benefit verification.

Having access to real-time benefits verification can save your staff from lengthy phone calls or being placed on long holds with insurance companies. In a busy office, the medical staff probably doesn't have enough time to call the insurance company anyway. You can save your office time and money by subscribing to or purchasing real-time benefits verification software. This will limit the amount of denials you receive due to:

  • Incorrect/Invalid subscriber number
  • Missing/Invalid group number
  • Coordination of Benefits information required
  • Requires referral/prior authorization
  • Not eligible on date of service

Electronic Billing

If you are still paper billing claims, then you may be losing up to 3 weeks or more in accounts receivable days. Most of the larger insurance payers offer electronic claim submission. You have the choice of direct billing or setting up an account with a clearinghouse.

A clearinghouse is a company that will accept all of your claims and electronically forward them to the insurance payers for processing.

They also have edits in place to check for errors in your claim to help avoid delays in billing.

The major benefit of electronic billing whether you use of clearinghouse or you direct bill is that you will speed up your claims processing. Paper billing can take up to 45 days for processing while electronic billing can take 7 to 21 days.

Electronic Remittance Advice (ERA)

Using electronic remittance advice (ERA) is a fast and accurate way to post your payments as well as adjustments and denials. The ERA, however, is not effective without the electronic funds transfer (EFT). EFT will assure that your payment will post directly to your bank account to reflect your ERA. You can sign up for these benefits directly or through a clearinghouse. The process will work similar to the electronic billing process.

Choosing the Best Software For Your Office

There are lots of software programs to choose from to assist you with your efforts to reduce your claims processing time. The decision on which program you choose will be simple if you follow a few simple tips.

  • Evaluate your needs
  • Look for a system that is user friendly
  • Find out if the software is compatible to your computer systems
  • Get quotes from at least 3 vendors
  • Weigh the pros and cons of each vendor

Continue Reading