Charge entry and claim preparation
Match encounter details and completed charges before preparing the claim; send documentation questions to the practice for clarification.
Medical billing
Medical billing
Connect charge entry, claim submission, payment posting, and follow-up with a medical billing workflow your practice can track.
Discuss medical billing
SERVICE OVERVIEW
Make each handoff clear.
A submitted claim is only one milestone. Billing work also includes resolving missing encounter information, checking submission responses, reconciling remittances, and deciding what happens to an unpaid balance. Clarinza RCM supports these handoffs so your practice can see both completed work and unresolved exceptions.
Claim review and submission tracking
Review acceptance responses and payer status so a transmission receipt is not mistaken for adjudication.
Payment posting and reconciliation
Compare remittance details with the account record and route unexplained differences for review.
Unresolved claim and patient balance follow-up
Record account status, responsible owner, next action, and relevant timing for unresolved claims and balances.
WORKFLOW IN PRACTICE
From a complete encounter to a resolved account.
Each stage depends on complete information, an accountable owner, and a clear route for exceptions.
- 01
Start with a complete encounter
Match encounter records with charge information and identify missing demographics, insurance details, or documentation. Questions that require clinical judgment go back to the practice. Establishing an exception queue helps prevent incomplete encounters from disappearing between teams.
- 02
Track the response, not just the submission
A transmission receipt does not establish that a claim will be paid. Track clearinghouse and payer responses, correct rejected submissions, and distinguish those rejections from adjudicated denials. Keeping the response history with the account makes the next action easier to understand.
- 03
Close the loop on payments
Reconcile remittance information with posted payments and adjustments. Investigate unresolved differences before transferring a balance for further follow-up. Reports should show where work is waiting, which exceptions recur, and what the practice needs to resolve.
INFORMATION TO ALIGN
What the team needs
Your practice management workflow, payer mix, encounter handoff process, current billing queues, and agreed access permissions.
VISIBILITY
What a useful review shows
Review submission exceptions, unposted remittances, unresolved claims, and aging balances with consistent reporting definitions.
Use approved systems for patient or practice records. Keep private information out of the public consultation form.
COMMON QUESTIONS
Questions about medical billing.
What information helps scope billing support?
Discuss your practice management workflow, payer mix, encounter handoff, access permissions, and current billing queues. Do not send patient details through the public inquiry form.
What happens when a claim is rejected?
Review the actual clearinghouse or payer response, identify the missing or incorrect information, and assign the correction to the appropriate team before resubmitting.
Does claim submission mean the claim was accepted?
No. Submission, clearinghouse acceptance, payer adjudication, and payment are separate milestones. A useful workflow tracks each response and the next action.
What information helps scope billing support?
Discuss your practice management workflow, payer mix, encounter handoff, access permissions, and current billing queues. Do not send patient details through the public inquiry form.
What happens when a claim is rejected?
Review the actual clearinghouse or payer response, identify the missing or incorrect information, and assign the correction to the appropriate team before resubmitting.
Does claim submission mean the claim was accepted?
No. Submission, clearinghouse acceptance, payer adjudication, and payment are separate milestones. A useful workflow tracks each response and the next action.
LET’S MOVE YOUR PRACTICE FORWARD
Ready to improve your revenue cycle workflow?
Connect with Clarinza RCM to discuss medical billing, payer enrollment, and revenue cycle support for your practice.
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Tell us what your practice needs.