We work with Availity, Waystar, Office Ally, Change Healthcare, TriZetto, and payer-direct portals. If your setup is hybrid (e.g., Athena PM with payer direct), we’ll support both pathways.
The Outsourcing Medical Billing Company helps healthcare providers cut down on claim rejections, claim denials, and payment delays by ensuring that every claim submission sent to the insurance payer meets compliance and clean-claim standards. We process high volumes of claims for multispecialty medical providers, FQHCs, and revenue cycle management (RCM) companies, ensuring end-to-end accuracy from 837 transmission formatting, payer ID matching, ANSI loop validations, ICD-10/ CPT coding logic, to post-scrubbing clearinghouse edits. Whether you’re using clearinghouses like Availity, Office Ally, Waystar, or Change Healthcare, we work within your existing systems or help transition to one that aligns better with your billing process and specialty.
We intake charges from your EHR or PM, apply batch validation protocols (ICD codes/CPT codes/NDC/HCPCS crosswalks, date of service logic, provider credential checks), and convert them to HIPAA-compliant ANSI 837 files for transmission. By ensuring compliance with industry standards and utilizing claim scrubbing techniques, we streamline the claims submission process, reducing errors and enhancing the efficiency of your billing services. This approach supports healthcare providers in maintaining accurate data and seamless revenue cycle management workflows.
Key Outputs:
We run pre-submission claims through your clearinghouse’s rules engine and fix payer-specific edits before they reach the insurance payer. This process ensures compliance with industry standards, reduces errors, and enhances the claims submission process, improving the efficiency of your billing services and supporting seamless revenue cycle management for healthcare providers.
We handle:
Many claim rejections happen after clearinghouse if scrub rules are too generic. Our payer-specific matrix includes real-time logic per region and specialty, ensuring compliance with insurance payer requirements and enhancing the claims submission process. This tailored approach supports healthcare providers in streamlining their billing services, reducing errors, and improving overall revenue cycle management.
Example Cases Solved:
Rejected claims are re-worked within 24 hours with documentation of original rejection reasons and the edit path followed. Our streamlined billing process ensures compliance with payer-specific requirements, reducing delays and improving the efficiency of your claims submission process. This approach supports healthcare providers in minimizing claim denials and maintaining a seamless revenue cycle.
This includes:
Based on previous implementations across multi-specialty groups, our claim scrubbing logic reduces preventable claim denials by eliminating:
Upcoding/undercoding mismatches
Missing subscriber data
Incorrect POS usage (especially for telehealth claims)
This ensures compliance with insurance companies’ requirements, streamlines the claims submission process, and supports healthcare providers in maintaining a seamless revenue cycle.
Industry average hovers around 85%. Our protocol-based claim checks raise this by 8–12% depending on your current baseline.
You get visual logs of:
Your in-house team submits claims, but you’re seeing >20% of them bounce back from clearinghouse.
→ We implement payer-specific scrub rules + auto-edit workflows to prevent resubmission loops.
You switched from Kareo to AdvancedMD, and your clearinghouse setup broke.
→ We handle clearinghouse re-mapping, payer list sync, and dual-routing during transition.
You have a backlog of 3,000+ unfiled claims due to EHR API failure.
→ We extract, convert, and push bulk claims via electronic data interchange (EDI) using direct submission where possible (avoiding 3rd-party delays).
We work with Availity, Waystar, Office Ally, Change Healthcare, TriZetto, and payer-direct portals. If your setup is hybrid (e.g., Athena PM with payer direct), we’ll support both pathways.
Yes. For Medicaid and WC claims that require CMS-1500 print-and-mail workflows, we can handle print-image generation and batching.
Rejections are reworked within 24 business hours. High-volume batches are escalated via priority routing.
We can log in directly or work through secure SFTP extraction. We’re compatible with DrChrono, Athenahealth, Kareo, AdvancedMD, eClinicalWorks, and over 20 others.
We’re HIPAA compliant, maintain secure 256-bit encryption for all data exchanges, and follow ANSI X12 EDI standards for all 837/835 transactions.
Streamline Your Claims Submission and Clearinghouse Services
If you’re looking to enhance the accuracy and speed of your claims submission and clearinghouse services, Outsourcing Medical Billing Services is here to assist. Our comprehensive, efficient service ensures that your claims are submitted promptly, reducing the chances of errors and delays. With our expertise in clearinghouse services, we help streamline the entire process, ensuring that your practice receives timely and accurate reimbursements. Let us take care of the claims submission process while you focus on delivering exceptional care to your patients.
Providing trusted medical billing solutions designed to streamline payment processes, reduce claim denials, and ensure efficiency tailored to your practice’s unique needs. Count on us for expert support you can rely on.
Kemp House, 152 – 160 City Road London, EC1V 2NX United Kingdom
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