Our Services

Claim Submission Services

At Maximum Billing, accurate and timely claims submission is the foundation of a healthy revenue cycle. We manage the complete electronic submission of your medical and dental claims to insurance payers, ensuring each claim is coded correctly, scrubbed for errors, and filed promptly so you get paid faster.

Our experienced billing team reviews every claim before submission to maximize first-pass acceptance rates and minimize costly denials and rejections. By catching issues early, we reduce rework, shorten your accounts receivable cycle, and keep your cash flow steady.

What Our Claims Submission Service Includes

• ✓  Electronic submission of primary, secondary, and tertiary claims to all major payers.
• ✓  Thorough claim scrubbing and validation to ensure clean, compliant submissions.
• ✓  Verification of patient and insurance information prior to filing.
• ✓  Prompt resubmission and correction of rejected or denied claims.
• ✓  Ongoing tracking and follow-up until each claim is adjudicated and paid.

Whether you are a mental health practice, a medical provider, or a dental office, our specialists handle your claims with precision and care so you can focus on your patients. Contact us today to learn how Maximum Billing can streamline your claims submission process and improve your bottom line.

How Our Claims Submission Process Works

1. Charge entry. Services, dates, diagnosis codes, and rendering providers are entered from your documentation or practice management system.
2. Coding review. Procedure and diagnosis codes are checked against each other and against the documentation, along with modifiers and units.
3. Claim scrubbing. Each claim is checked against payer-specific rules before it is sent, so errors are caught while they are still cheap to fix.
4. Electronic submission. Clean claims go to the payer through a clearinghouse, in the format that payer requires.
5. Acknowledgment. We confirm each claim was accepted by the clearinghouse and by the payer, and work any rejection the same week it appears.
6. Tracking to payment. Accepted claims are monitored until they are adjudicated and paid, and anything that goes quiet is followed up.

What We Check Before a Claim Is Sent

• Patient name, date of birth, and member ID exactly as the payer has them.
• The correct payer and plan, including behavioral health carve-outs and Medicaid managed care plans.
• Rendering and billing provider NPIs, taxonomy, and tax ID.
• Place of service, including telehealth rules for each payer.
• Modifiers, units, and diagnosis pointers.
• Authorization and referral numbers where the plan requires them.
• Coordination of benefits order for patients with more than one plan.
• Attachments, such as radiographs or narratives, for dental and surgical claims.

Much of this depends on work done before the visit. See our insurance verification services.

Medical, Dental, and Behavioral Health Claims

Each specialty submits claims differently. Medical and behavioral health claims use the professional claim format with CPT or HCPCS procedure codes and ICD-10-CM diagnosis codes. Dental claims use the dental claim format with CDT codes, tooth numbers, surfaces, and quadrants, and often need attachments. Behavioral health claims add their own rules for time-based psychotherapy codes, telehealth modifiers, and carve-out administrators. Oral surgery practices may submit both dental and medical claims for the same patient. We submit each in the format and with the details its payer expects. Learn more about our therapy billing, dental billing, and oral surgery billing.

Secondary and Tertiary Claims

When a patient has more than one plan, the secondary claim can only be filed after the primary plan has paid, and it usually needs the primary payer’s explanation of benefits or remittance data. Secondary claims are easy to forget once the primary payment arrives, and many practices leave real money uncollected there. We file secondary and tertiary claims as soon as the primary payment posts, and track them to payment like any other claim.

Rejections Worked the Same Week

A rejected claim was never processed, so it will not appear on any remittance. If no one is watching clearinghouse and payer acknowledgment reports, a rejected claim can sit unnoticed until it is past the payer’s filing deadline. We review rejections daily, fix the data problem, and resubmit, so a simple error does not become a lost claim. When a claim is processed and denied instead, it moves to our claims denial management process.

Timely Filing

Every payer sets a deadline for submitting claims, and some are much shorter than practices expect. Many commercial plans allow 90 to 180 days from the date of service, Medicare generally allows one year, and Medicaid programs set their own limits. Corrected claims and appeals have their own deadlines as well. Submitting claims within a few days of the visit, and tracking every claim until it is paid, keeps timely filing from ever becoming the reason a claim is not paid.

Common Claim Submission Errors

• A member ID or date of birth that does not match the payer’s records.
• A claim sent to the medical plan when behavioral health benefits are carved out.
• A missing or incorrect modifier, especially on telehealth claims.
• Diagnosis codes that do not support the procedure billed.
• A resubmission sent as a new claim instead of a corrected claim, which creates a duplicate denial.
• A rendering provider who is not yet credentialed with that payer.

Claims Submission Numbers We Track

• First-pass acceptance rate: the share of claims accepted without a rejection.
• Clean claim rate: the share of claims paid on first submission.
• Time from service to submission: how quickly charges become claims.
• Rejection reasons: which data problems keep repeating, so they can be fixed at the source.

These are reported to you monthly as part of our revenue cycle management reporting.

Why Choose Maximum Billing for Claims Submission

What sets our claims submission apart is the attention that happens before a claim ever leaves our office. Rather than simply transmitting claims and hoping they stick, we treat first-pass acceptance as the goal, verifying details, matching each claim to payer-specific requirements, and resolving red flags up front. The result is fewer rejections, faster reimbursement, and far less back-and-forth for your staff. You also get transparent reporting at every stage, so you are never left guessing about where a claim stands or why a payment is delayed.

Frequently Asked Questions

How quickly are claims submitted after I send my charges?
We submit clean claims promptly, typically within one to two business days of receiving complete charge information. Prompt filing shortens your payment cycle and keeps cash flow predictable.

What happens if a claim is rejected or denied?
We identify the reason, correct the underlying issue, and resubmit promptly, then track each corrected claim through to payment so nothing slips through the cracks.

Do you handle both medical and dental claims?
Yes. We submit medical, dental, and behavioral health claims to commercial and government payers, and we tailor each submission to that payer’s specific rules.