How often do you submit claims?

Daily. Batching claims weekly adds days of avoidable delay to every encounter. Daily submission keeps AR days low and gets rejections in front of us fast.

What clean-claim rate do you target?

99% or higher, first-pass. We report the actual monthly rate on your scorecard, so it's a measured result you can verify — not a marketing claim.

Do you handle secondary claims automatically?

Yes. Once the primary payer adjudicates, secondary and tertiary claims are generated and submitted with the primary EOB/ERA attached.

What happens to claims rejected at the clearinghouse?

They're worked the same day. A clearinghouse rejection is an early warning; corrected quickly it never becomes a payer denial.

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Billing & Claim Submission

The problem

A claim that goes out with an error comes back as a denial — and every denial is rework, delay, and risk of eventually writing the money off. Many practices submit in batches, days after the encounter, with minimal scrubbing, and accept a clean-claim rate in the low-to-mid 90s as normal. That gap between 93% and 99% is real money sitting in AR instead of your bank account.

How NuGenera Health does it

We submit claims daily, not weekly, and we scrub every claim before it leaves. Charge entry is reconciled against the schedule so nothing is missed, and each claim runs through payer-specific edits — demographics, coverage, coding, modifiers, and medical-necessity checks — before submission. Our target is a clean-claim rate of 99% or higher, and we report the actual rate every month.

Rejections at the clearinghouse are worked same-day, because a rejection caught early is a correction, while a rejection ignored becomes a denial. We manage clearinghouse connections, monitor acknowledgment reports, and confirm that submitted claims actually reach the payer rather than silently failing.

Because clean-claim rate is the leading indicator of a healthy revenue cycle, it sits at the top of your scorecard alongside AR days and denial rate — the three numbers that tell you, at a glance, whether the cycle is working.

Key capabilities

Daily charge entry and reconciliation against the schedule
Pre-submission claim scrubbing with payer-specific edits
Primary, secondary, and tertiary claim submission
Clearinghouse management and acknowledgment monitoring
Same-day clearinghouse rejection resolution
Clean-claim rate reporting on the monthly scorecard

Technology that supports it

We operate in your EHR/PM and connect through your clearinghouse (Waystar, Availity, or Office Ally). Automated scrubbing applies thousands of edits before submission; specialists handle the exceptions. Analytics track first-pass acceptance by payer so recurring edit failures get fixed upstream.

Frequently asked questions

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