Business hours: 9:00 to 5:00 | Monday to Friday


In addition to many other important services, third-party billing companies also offer comprehensive medical billing services to healthcare providers. Healthcare billing providers take care of the financial side of healthcare services. They process insurance claims by verifying patient eligibility and medical coding accuracy, and submit claims to insurance providers for on-time and complete reimbursements.

For healthcare providers and institutes, the main goal is to care for patients. However, after the appointments and treatments, the big task is getting paid.

That is where the medical billing companies come in. Outsourcing medical billing to experts means they send the billing claims to insurance companies. Medical billing service providers make sure that healthcare professionals receive the right payment for services provided. Such companies handle the paperwork, correct any mistakes, and take care of the insurance details.

In simple terms, healthcare professionals handle the patient care, medical billing service providers take care of the bills. It is a teamwork that makes sure that healthcare practices run smoothly for all stakeholders.

What are Medical Insurance Claims?

Medical insurance claims are invoices that medical practices send out to their patient’s insurance providers. This is done to receive reimbursements for services and treatments offered. If your healthcare practice accepts insurance, this process will become an important part of your monthly cash flow. Accepting insurance can let you work with more patients, which is essential to grow your business.

Role of Billing Companies in Insurance Claims

Managing insurance claims might seem straightforward, however there is quite a bit that goes on behind the scene. Medical billing companies ensure healthcare providers get full and timely payments without any delays.

How do Medical Billing Service Providers Manage the Insurance Claim Submission Process?

Running a small-scale medical practice requires a lot of knowledge, organization, and hard work. Not only it is important to track patient records, treatments and diagnosis, but it is also important to manage the financial side of things. These include managing processes with insurance in medical billing, handling payments, and more.

This is why most healthcare practices outsource their billing operations to specialized medical billing service providers. When you outsource billing, the billing services provider handles the entire medical claims process, from insurance claims submissions to managing denials.

But how exactly do third-party medical billing companies handle the insurance claims submission process?

1. Claim Preparation

Prior to submitting a claim to an insurance company, medical billing provider must first collect patient information. This information includes patient’s name, birthdate, and insurance information, etc. They must then obtain the required clinical data from the healthcare practice, such as the diagnoses codes, CPT codes – related to the provided services. All of this information is important and used to prepare an insurance claim for submission.

2. Insurance Claims Submission

After the claim is prepared, the medical billing service provider will submit it to the insurance provider. It is important to select the right electronic format so that the claim is accepted by the insurance provider. Moreover, they must also properly format the medical claims according to the insurance provider’s requirements.

3. Claims Follow-up

After claim submission, billing providers follow up with insurance providers to ensure claims are properly received and processed. If there happen to be any errors, discrepancies, or denials, the billing providers address them promptly. The claims follow-up process also involves negotiating with insurance companies to ensure timely reimbursements.

4. Payment Posting

After the claim is processed and accepted by the insurance company, the medical billing services providers will post payments to the patient’s account. This ensures that medical practices are reimbursed fully and timely. Moreover, the billing services providers can process refunds to patients in case of overpayments.

5. Handling Claim Denials

There are some instances where claims are denied by insurance companies. In such cases, medical billing providers assist by appealing the decisions and working with insurance providers to resolve issues.


A healthcare practice spends its time helping patients and not following up on insurance reimbursements. Therefore, a complete solution that includes medical billing services can help streamline your insurance claims submissions. As your healthcare practice grows, so will your needs. At some point, you will have to decide between hiring an in-house medical billing team or outsourcing to a third-party medical billing company. It is important to note that there are benefits to both approaches. However, outsourcing offers your practice access to a wide range of specialized services in addition to claims management. Most billing companies provide support for appeals, coding, technology support, accounts receivable, credentialing, billing audits, payer contract negotiations, and more.

Frequently Asked Questions

After claim processing is complete, the only thing left to do is to wait for patients to pay the remaining amount. It is best to keep a follow-up strategy in place to ensure you get paid in a timely manner.

Insurance payments can take close to 30 days to process. Insurance carriers must review each claim to ensure that the treatment offered is valid and covered under a patient’s plan. Often, an individual agent is responsible for investigating multiple claims, which slows down the process.

The information needs to be up-to-date and accurate. The information includes the patient’s name, address, insurance information (including coverage) and any other important data. Even a single typo or missing piece of information in patient data can lead to insurance claims rejection.