Mid cycle
Claims that get worked, not just filed
Charge capture, coding review, scrubbing, submission and disciplined follow-up across the entire claims lifecycle. Every claim is tracked to payment, and nothing is allowed to age quietly in a worklist nobody opens.
Submitting a claim is the easy part
Any clearinghouse will transmit a claim. The difference between a practice collecting what it earned and one quietly writing off six figures a year is what happens in the weeks after submission — and whether anyone notices when a payer simply goes quiet.
Initial denial rates reached 11.81% of claims in 2024 and have risen steadily (Kodiak Solutions, 2025). Meanwhile 68% of providers say submitting clean claims is harder than it was a year earlier (Experian Health, 2025). Payers have automated their side of this exchange faster than providers have: more than half of health plans now use AI in administrative workflows, against only a quarter of provider organizations (CAQH Index, 2026).
That asymmetry is the problem we exist to close, and it is closed by people who know how each payer behaves — not by transmitting faster.
- Charge capture reviewed so billable work is not lost before it is billed
- Coding reviewed against documentation and payer-specific requirements
- Claims scrubbed against payer edits before submission
- Electronic submission with acknowledgement and rejection monitoring
- Payer follow-up on a defined cadence, not when someone remembers
- Payment posting with ERA reconciliation against expected contract rates
- Timely filing deadlines tracked so claims never die of age
How it works
What we actually do
Charges are captured and reviewed
Charge lag is invisible revenue loss: every day between the date of service and the date the charge posts is a day added to days in A/R. We watch the gap and flag missing charges.
Coding is reviewed before submission, not after denial
Documentation is checked against what is being billed, with attention to the modifier and specialty-specific issues that drive downcoding and denial in your particular field.
Claims are scrubbed, then tracked
Clean claim rate measures what clears your edits. First-pass resolution measures what actually gets paid on first submission. They are not the same number, and we report both.
Follow-up happens on a schedule
Claims are worked by age and payer on a defined cadence. A payer that has gone silent is treated as a problem to chase, not a claim to wait on.
Payments are reconciled against the contract
Posting is not just recording what arrived. It is checking what arrived against what the contract says should have arrived — which is how underpayments surface.
Common questions
What practices ask us about this
What is the difference between clean claim rate and first-pass resolution?
Clean claim rate is the share of claims that clear your scrubber and edits without manual intervention before submission. First-pass resolution rate is the share adjudicated and paid on first submission with no rework. A practice can have a 98% clean claim rate and a much lower first-pass rate. Any billing partner that uses the terms interchangeably is worth questioning.
Do you work every claim regardless of value?
Yes, and we put it in writing. Small balances are exactly where percentage-based billing partners lose interest. Nothing is written off without your approval.
How quickly are charges submitted?
Charge lag targets are agreed during onboarding and reported against. Industry guidance generally places complete charge capture within a few days of service.
Will you work in our system or yours?
Yours. We operate inside your existing EHR and practice management system.
What happens to claims approaching timely filing?
They are tracked and escalated by deadline. A claim lost to timely filing is unrecoverable revenue, which makes it the least forgivable failure in this work.
Related services
The rest of the cycle
Find out what your revenue cycle is actually leaving behind.
Request a consultation and a revenue cycle specialist will walk through your denial patterns, A/R aging and payer mix with you. No obligation, and no software to install.