Claims management: full scope, no add-ons
Every engagement includes the complete scope below. No hidden tiers, no extra fees.
Where claim revenue leaks before anyone notices
Most practices don't lose money on one big claim. They lose it in small, repeatable ways: a charge that never reached the clearinghouse, a rejection nobody reworked, a partial payment posted as if it were complete. Experian Health State of Claims 2025 puts the industry-wide initial denial rate at 11.8% for 2024, up from 10.2% in 2020. On a practice collecting $1.2 million a year, every point of denial rate is roughly $12,000 of billed revenue that has to be reworked, and some of it never comes back.
Single-specialty groups tracked by MGMA sit near 8% on first submission. The practices that beat that number don't have smarter billers. They have a tighter loop: clean charge capture, scrubbing before submission, daily rejection work and a second look at every payment. That loop is what we run for you.
Timing matters as much as accuracy. Medicare gives you 12 months from the date of service to file, and many commercial contracts allow only 90 to 180 days. A claim that sits in a rejection queue for three weeks isn't just late. It's three weeks closer to a deadline nobody will negotiate.
Short version: clean claims out fast, problems worked daily, every payment checked against what it should have been.
How we take over your claims workflow
- Week 1: Connect and baselineWe take role-based access to your practice management system and clearinghouse, pull 90 days of claims, and measure your first-pass rate, rejection rate and days to payment.
- Week 1 to 2: Charge capture rulesWe map every charge source (EHR, superbills, procedure logs) and set same-day entry rules so charges can't stall between the exam room and the billing system.
- Ongoing: Scrub and submitEvery claim runs through payer-specific edits before release, then goes out electronically within 24 hours of service, secondary claims included.
- Daily: Work rejections and denialsRejections get fixed the same day. Denials go into a worklist sorted by dollar value and appeal deadline, with the root cause recorded on each one.
- Daily: Post and reconcileWe post ERAs, compare each payment with your contracted rate and flag short-pays so underpayments get disputed while the window is open.
- Monthly: Report and adjustYou get first-pass rate, denial rate by payer and reason, days in A/R and a short list of what we changed and why.
What claims management costs
Full-service billing is priced as a percentage of collections: roughly 5% to 7% for solo and small practices, 3.5% to 5% for mid-size groups, and 2% to 3.5% for large groups. There are no setup fees, no minimum monthly charge and no long-term lock-in; you can leave with 30 days notice. The full breakdown is on our pricing page.
We confirm your rate in the free revenue assessment, after we've looked at your specialty, payer mix and volume. If you only want a second opinion on your current numbers, the assessment includes a 90-day billing analysis with no commitment.
Questions we hear most
How fast do you submit claims after a visit?
Within 24 hours of the date of service once the charge reaches us. Charges usually arrive the same day from your EHR or superbill, and anything missing documentation goes back to your team as a written question instead of sitting in a queue.
What's the difference between a rejection and a denial?
A rejection is stopped before the payer accepts the claim, usually for a data error such as a wrong member ID. You fix it and resend it. A denial is a decision made after processing and needs a correction, an appeal or both. We work rejections the same day and denials by dollar value and deadline.
Do you work inside our software or move us to yours?
Inside yours. We use role-based access to your practice management system and clearinghouse, so your front desk and clinicians keep the workflow they know. We work in 40+ EHR and PM platforms.
How do you handle secondary claims and patient balances?
Secondary claims go out as soon as the primary ERA posts. Patient balances move to statements after insurance finalizes, and we take the balance questions so your front desk doesn't have to.
Related: Denial management · Aged A/R recovery · Front-end access and prior authorization · How to reduce days in A/R.
Stop leaving claims revenue behind.
Our free revenue audit shows exactly where your current billing process is leaking money, and how much Rcmaxis would recover. Results in 5 business days, no obligation.