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REVENUE CYCLE MANAGEMENT

Claim Preparation Services That Prevent Denials Upfront

Claim preparation services check every claim for errors before it is sent to the payer. ZanexMed verifies eligibility, reviews coding and documentation and scrubs each claim against payer rules, so more claims are paid on the first submission.
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  • Eligibility and authorization checked first
  • Certified coders review every claim
  • Payer specific scrubbing rules
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    What Are Claim Preparation Services?

    Claim preparation services are the checks and corrections made on a claim before it is submitted, so the payer can process it without rejection or denial. They cover eligibility, patient and insurance data, charge capture, coding, authorization and claim scrubbing.

    Preparation is the cheapest place to fix an error. A mistake caught before submission costs a few minutes. The same mistake caught after a denial costs rework, appeal time and a longer wait for payment.

    Many denials come from data that was wrong at the start, not from the payer. Strong claim preparation services remove those errors at the source. Many payers also follow the bundling rules of the Centers for Medicare and Medicaid Services.

    Our 6 Key Claim Preparation Checks

    Our claim preparation services run the same six checks on every claim.

    1. Eligibility and benefits

    We confirm active coverage, plan type and benefits before the claim is built.

    2. Demographics and insurance

    Names, dates of birth and subscriber IDs are matched to the payer record.

    3. Charge capture

    We confirm every billable service in the visit was captured.

    4. Coding review

    Certified coders check CPT, ICD 10 and modifiers against the documentation.

    5. Authorization and necessity

    We confirm prior authorization and that diagnoses support the service.

    6. Claim scrubbing

    Claims are tested against payer rules and edits before they are sent.

    Claim preparation services workflow from eligibility check to clean claim submission

    Common Claim Errors We Catch

    These errors cause most avoidable rejections and denials. Our claim preparation services check for each one.
    ErrorWhat happens if missedOur check
    Wrong or missing subscriber IDClaim is rejectedEligibility and ID match before submission
    Missing modifierDenial or reduced paymentCoding review against documentation
    No prior authorizationDenial (CO-197)Authorization tracking before the visit
    Diagnosis not linked to the procedureMedical necessity denialCode linkage review
    Wrong place of servicePayment reduction or denialPlace of service validation
    Duplicate claimDenial (CO-18)Duplicate check before release

    Why a High Clean Claim Rate Matters

    The clean claim rate is the percentage of claims accepted and processed on the first pass. A higher rate means fewer denials, less rework and faster payment.

    We track this rate by payer and use it to tune our scrubbing rules. When a payer keeps rejecting the same thing, we add a rule for it. Learn how we handle claims that still get denied in our denial management services and how we send them out in our claim submission services.

    GOT QUESTIONS?

    Claim Preparation Services FAQs

    Claim preparation services are the checks and corrections made before a claim is submitted. They cover eligibility, patient data, coding, authorization and scrubbing, so the payer can process the claim on the first pass.
    A clean claim is one the payer can process without extra information or correction. The clean claim rate is the percentage of claims accepted and processed on the first pass.
    Claim scrubbing is software and manual review that checks a claim against payer rules, coding edits and data requirements before submission.
    Common causes are wrong patient or insurance data, missing information, invalid codes and formatting errors. Most are preventable with checks before submission.
    They catch errors before the payer sees them. Each check blocks a common denial cause, from eligibility and authorization to coding and place of service.
    Most billing companies charge a percentage of collections, typically 3% to 8% depending on volume and services. ZanexMed offers transparent plans with no hidden fees. See our pricing page for details.

    RELATED SERVICES

    Explore More ZanexMed Billing Services

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    Medical Coding

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    Denial Management

    Find the root cause of denials and appeal with proof.

    EDI Medical Billing

    Electronic claims, ERAs and eligibility handled for you.

    Ready to Send Cleaner Claims?

    Talk to ZanexMed about claim preparation services and get a free review of your claim error rate.
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