Proactive claims and full cycle billing.
After the Claim Is Posted
When a claim is submitted to a payer, most billing teams consider that cycle closed. They move on to the next batch. At eClaimWorks, that is where our real work begins.
According to CMS data, 30% of claims are not paid on first submission. Of those, 60% are never resubmitted. That number represents thousands of dollars per provider, per year, simply written off because no one is following up. Payers benefit from that pattern. Your practice should not be funding it.
We built a dedicated Denial Analyst function inside our operations for exactly this reason. Every denied, rejected, or partially paid claim is assigned to a team member who owns it through resolution, whether that means a first-level appeal, a second-level appeal, or an external review. Nothing owed to your practice is left unworked.
Built to Serve Your Practice
We focus on small and mid-sized practices because their billing needs are different from large hospital systems, and because they are the practices most often underserved by large RCM companies that treat them as low-priority accounts.
At eClaimWorks, a solo internist and a 10-provider group get the same level of service. Physicians can request direct time with our key billing personnel when issues arise. You are not routed through a general support queue. You talk to the person who handles your account.
That kind of access is not standard in this industry. We built it in from the beginning because we knew it was what small practices actually needed.
Payer policies change. CMS updates coding guidelines. New bundling rules go into effect with no announcement. A billing team that is not staying current with these changes will cost you money in ways that never show up as an obvious error line.
Every biller and coder on our team carries a minimum of four years of active billing experience. Our in-house training program uses CMRS and CPC templates, and all staff undergo ongoing certification updates as regulations evolve. When a payer changes how it processes modifier 25 claims or adjusts its prior authorization requirements, our team knows before it affects your submissions.
You are not paying for someone to learn on the job with your claims.
YOUR TEAM
When you work with eClaimWorks, a specific team is assigned to your account. They learn your specialty, your payer mix, and your practice patterns. They are not rotating through a shared queue of unrelated accounts.
That consistency matters for denial management. Our Denial Analysts who work 90-plus-day buckets need deep knowledge of individual payer appeal requirements. A different person handling your account each week cannot build that knowledge. A dedicated team does.
We also provide front office and EHR tools so your team can manage scheduling, check-in, checkout, and patient communication from a single system. Your billing partner and your practice management software are not separate problems.
Beyond Billing
Most billing companies stop at claim submission. Our service spectrum covers everything that affects your revenue cycle from the moment a patient books an appointment to the last dollar collected on that visit.
- Credentialing and Enrollment. Getting paneled with payers is slower and more complex than most providers expect. We manage the full enrollment process so you start billing without delays.
- Eligibility and AWE Alerts. We verify insurance coverage and benefits before every visit and issue Advance Warning Event alerts when coverage issues are identified in advance.
- Coding Audits. Periodic internal audits identify coding trends that lead to downcoding or bundling denials before they become a pattern.
- MIPS and PQRS Reporting. We handle all data collection, score optimization, and CMS submission for eligible providers so reporting gaps do not cost you a portion of your Medicare payments.
- MIS Reports. Monthly management information reports give you a clear financial picture of your practice, including denial trends, payer performance, and collection ratios.
The Ever Evolving Claim Lifecycle
Pre-Visit Verification
Insurance eligibility and benefit details are verified before the patient arrives. Prior authorizations are obtained where required. Any coverage issues trigger an alert to the practice before the appointment takes place.
Claim Scrubbing
Before any claim is submitted, it passes through our internal audit process. ICD and CPT codes are validated for compatibility per CMS guidelines. Modifier rules are checked. Bundling conflicts are flagged. A claim does not leave our system with a known error in it. This is how we maintain an 83% clean claims rate.
Claim Submissions
Claims are submitted electronically through the clearinghouse. Clearinghouse edits and rejections are worked the same day they come back. A rejection is not set aside for the weekly queue. It is addressed immediately.
Payment Posting and Reconciliation
Payments are posted and reconciled against expected reimbursements. Underpayments are flagged. We run periodic fee schedule audits to verify payers are honoring contracted rates. The MGMA estimates payers underpay U.S. practices by 7 to 11% on average. We catch those discrepancies and recover them.
Denial Analysis and Appeals
Every denied or partially paid claim is assigned to a Denial Analyst. They review the denial reason, gather supporting documentation, and file the appropriate level of appeal. For 90-plus-day accounts, our analysts have deep knowledge of payer-specific appeal requirements. We pursue first-level, second-level, and external appeals as needed. Our denial management process produces a Net Collection Rate of 94%.
Patient Balance and Collections
Patient statements are dispatched and followed up. Balance collections are coordinated between your practice and, when necessary, collection agencies. Nothing owed on a completed visit is written off without a documented reason.
Results Across Our Client Base
clean claims rate maintained across all clients
Net Collection Rate through denial management
average net collection rate (up from 89.7% before eClaimWorks)
client retention over two or more years
