Ensuring Timely, Accurate Reimbursement Through Proactive Claim Management

What Is Claims Submission & Follow-up?

Claims submission is the process of sending medical claims to insurance payers—either electronically or via paper—based on the services rendered to patients. Each claim must include accurate patient information, proper coding, supporting documentation, and must comply with payer-specific requirements.

Follow-up, on the other hand, is the ongoing effort to track those claims post-submission, resolve rejections or denials, and ensure the healthcare provider receives full payment. It involves communicating with insurance companies, reviewing remittance advice, identifying patterns in denials, and taking corrective action swiftly.

Together, these processes are crucial for maintaining a healthy revenue cycle and preventing revenue leakage.

Our Approach at RICH SOLUTIONS LLC

We’ve developed a structured, transparent, and proactive approach to claims management that ensures accuracy, efficiency, and accountability at every step:

1. Claim Preparation & Validation

Before a claim is even submitted, we conduct a rigorous pre-submission check to ensure all data is complete, coded accurately, and aligned with payer requirements. This includes:

• Verifying patient demographics and insurance eligibility.
• Reviewing diagnosis and procedure codes (ICD-10, CPT, HCPCS).
• Applying the appropriate modifiers.
• Attaching necessary supporting documentation.
• Validating units, service dates, and referral information.

This initial validation significantly reduces the risk of rejections and improves clean claim rates.

2. Electronic & Paper Claim Submission

Once validated, claims are submitted through secure, HIPAA-compliant electronic channels (EDI) or on paper when required by specific payers. Our billing system integrates with major clearinghouses and payer portals to ensure fast, accurate transmission.

• Electronic Claims: Submitted instantly to most commercial payers, Medicare, Medicaid, and clearinghouses.
• Paper Claims: Printed and mailed with proper documentation to payers who require or prefer hard copies.

We track each submission and generate confirmation receipts to ensure every claim reaches its intended destination.

3. Real-Time Claim Tracking

After submission, our system tracks the claim status in real-time. We use advanced billing software to monitor each claim through every stage—acknowledgement, processing, adjudication, and payment.

4. Proactive Claim Follow-up

Most revenue is lost not in the submission, but in poor or delayed follow-up. That’s why we take a proactive approach to follow-up, contacting payers regularly to:

• Confirm claim receipt and processing status.
• Resolve pending or delayed payments.
• Correct and resubmit denied claims.
• Appeal underpaid or rejected claims with necessary documentation.
• Identify root causes of denials to prevent future occurrences.

We don’t wait for payment to be late. Our team begins follow-up efforts immediately after the payer’s standard turnaround time passes.

5. Denial Management & Appeals

Denials are inevitable—but leaving them unresolved should never be acceptable. At RICH SOLUTIONS LLC, we treat every denial as a learning opportunity and a recovery opportunity. We:

• Analyze the denial reason codes.
• Cross-reference documentation and payer policy.
• Correct coding, eligibility, or authorization errors.
• Prepare and submit appeal letters with required evidence.
• Track appeal progress until resolution.

Our detailed tracking systems and expert billing specialists ensure that denied claims don’t stay that way for long.

6. Secondary & Tertiary Payer Submission

We also handle billing to secondary and tertiary insurers once the primary payer responds. We ensure coordination of benefits (COB) is properly applied, and every source of potential reimbursement is pursued on your behalf.

7. Patient Responsibility Posting

When balances are transferred to patient responsibility, we ensure accurate and timely posting of co-pays, deductibles, and coinsurance. We offer support for statements, payment plans, and patient communication to ensure transparency and customer satisfaction.

Why It Matters

Without a strong claim submission and follow-up process:

• Revenue gets delayed or lost.
• Claims get denied unnecessarily.
• Patient accounts become confusing or inaccurate.
• You lose time trying to fix mistakes that could have been prevented.

Our process not only reduces denial rates but also improves cash flow, increases patient satisfaction, and provides the peace of mind that your financial backend is in expert hands.

Key Benefits of Our Claims Submission & Follow-up Service

• Faster Reimbursements: Clean claims submitted quickly = faster payments.
• Improved Cash Flow: Timely follow-up prevents aging receivables.
• Reduced Denials: We resolve errors before they reach the payer.
• Higher Collection Rates: We chase every dollar you’ve earned.
• Lower Administrative Burden: Your staff can focus on patient care.
• Complete Transparency: You get regular updates and performance reports.

Our Technology Advantage

• Real-time claim scrubbing and alerts.
• Denial analytics and tracking.
• Dashboards for AR aging, outstanding claims, and payment status.
• HIPAA-compliant portals for secure document sharing.

This technology allows us to manage claims across multiple providers, specialties, and locations with consistency and accuracy.

Who Benefits from This Service?

Our Claims Submission & Follow-up service is perfect for:

• Independent practices and clinics
• Group medical practices
• Behavioral and mental health professionals
• Physical therapy and chiropractic offices
• Ambulatory surgery centers
• Any healthcare provider looking for consistent cash flow

Let Us Help You Get Paid—Faster and Fully

You work hard to provide quality care. You deserve to be paid—on time, in full, and without constant follow-up. At RICH SOLUTIONS LLC, we make that happen. Our Claims Submission and Follow-up service ensures that no claim is overlooked, no payment is unnecessarily delayed, and no revenue is left uncollected.

We don’t just submit claims—we fight for every reimbursement. We track, we follow up, we fix errors, and we never let denials define your revenue cycle. With us by your side, you can confidently focus on your patients, knowing your billing is in the hands of professionals who care as much as you do.