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Core RCM
Claims Management
Full lifecycle claim oversight from submission to final resolution.
Overview
What this service covers
Claims management provides structured oversight across the entire claim journey, combining automated edit checks with specialist review to maximize clean claim rates and reduce time to payment.
Process
01
Edit resolution
Claims failing payer or clearinghouse edits are corrected and resubmitted.
02
Status monitoring
Claim status is tracked across payer portals and clearinghouse feeds.
03
Exception handling
Stuck or rejected claims are escalated for specialist resolution.
04
Lifecycle reporting
Claim throughput and aging are reported at regular intervals.
Key Responsibilities
- Claim edit and rejection resolution
- Payer portal and clearinghouse monitoring
- Timely filing deadline tracking
- Claim status reporting
Benefits
- Improved clean claim and first-pass rates
- Reduced claim aging
- Fewer timely filing losses
Quality Controls
- Automated pre-submission edit checks
- Timely filing deadline monitoring
- Weekly claim aging review
Get Started
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