Claim submission is the process of transmitting a completed medical claim to the payer for reimbursement, typically through an electronic clearinghouse or, for a small number of payers, on paper. Before it reaches adjudication, a clean claim must pass scrubbing edits at the clearinghouse and meet each payer's specific formatting requirements, and errors at submission result in rejections that delay payment and erode timely filing windows. Billed Right submits claims electronically through certified clearinghouses with a scrubbing process that catches errors before they ever reach the payer.
The Cost of Claim Submission Errors
Rejected claims are often confused with denied claims, but they're fundamentally different problems. A rejection means the claim never reached the payer at all. It failed a formatting or data edit at the clearinghouse and bounced back before adjudication ever began. A denial, by contrast, means the payer received and processed the claim and decided not to pay it. Rejections have to be corrected and resubmitted, often within the same tight timely filing window as the original claim, and a rejection that isn't caught quickly can eat through that window entirely.
Each rejection costs staff time to identify the error, correct the claim, and resubmit it, and that time adds up fast for practices with any meaningful claim volume. According to the Medical Group Management Association, the average cost to rework a denied or rejected claim is $25 per claim, and for practices submitting hundreds of claims per week, that cost compounds rapidly into a significant operational burden. Delayed resubmission also means delayed payment, so a backlog of unresolved rejections shows up directly in A/R aging.
How Billed Right Handles Claim Submission
- Electronic claim submission through certified clearinghouses for all major payers
- Claim scrubbing before submission to catch coding errors, missing fields, and payer-specific formatting issues
- Paper claim submission for payers that do not accept electronic filing
- Timely filing deadline tracking per payer so no claim is lost to filing limit expiration
- Rejection follow-up and resubmission within 24-48 hours of clearinghouse response
- Monthly submission accuracy and rejection rate reporting by payer and code type
Billed Right has provided medical claim submission services since 2006, serving practices across the US from our base in Longwood, Florida.
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Top 5 Claim Submission Problems We Solve
Claims Rejected at the Clearinghouse Due to Formatting Errors
A missing field or incorrectly formatted payer ID bounces the claim back before it ever reaches the payer.
Missing or Incorrect Payer ID Causing Claims to Route to the Wrong Payer
The claim submits successfully but goes to the wrong payer entirely, delaying payment while it gets redirected.
Timely Filing Deadlines Missed
Delayed charge entry or a resubmission backlog can let a correctable claim run out its filing window and become permanently uncollectable.
Paper Claim Errors for Payers That Do Not Accept Electronic Submission
Paper claims skip clearinghouse scrubbing entirely, so formatting and coding errors often aren't caught until the payer denies the claim.
No Visibility Into Claim Status After Submission
Without daily tracking of clearinghouse acknowledgements, practices don't know a claim rejected until weeks later, when the filing window may already be closing.
What to Expect
Setup
Payer enrollment, clearinghouse connection, and timely filing rules configured per payer.
Scrubbing
Every claim reviewed for errors before leaving the practice.
Submission
Electronic and paper claims submitted to the correct payer on the correct schedule.
Tracking
Clearinghouse acknowledgements and payer responses monitored daily.
Reporting
Monthly claim submission accuracy, rejection rate, and timely filing compliance report.
Frequently Asked Questions
A rejection means the claim never reached the payer. It failed a clearinghouse edit and bounced back before adjudication. A denial means the payer received and processed the claim and decided not to pay it. Rejections are corrected and resubmitted quickly; denials typically require an appeal and take much longer to resolve.
Every claim is checked against clearinghouse and payer-specific edits before it leaves the practice: verifying required fields, payer IDs, code formatting, and modifier logic, so errors get caught and corrected before submission instead of coming back as a rejection.
We work with major certified clearinghouses and route each claim through the connection appropriate for that payer, so submission format and edits match what the payer actually requires.
We track which payers still require paper claims, prepare and mail those claims on the same schedule as electronic submissions, and apply the same review process before they go out since paper claims don't get clearinghouse scrubbing.
We review the rejection reason, correct the claim, and resubmit it within 24-48 hours, tracking the timely filing deadline the entire time so a rejection doesn't turn into a permanently uncollectable claim.
Every payer has its own timely filing window, and we track those deadlines per claim from the date of service, not just at submission, so a rejection or correction cycle never accidentally runs out the clock.
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ReadReady to Get Claims Out Clean the First Time?
Schedule a conversation with our claim submission team. We will review your current submission workflows and rejection rates, identify where claims are getting caught up before they reach the payer, and show you what we would do differently.