Claims management is everything that happens to an insurance claim after the visit: building it correctly, getting it through the clearinghouse and the payer’s front-end edits, tracking it while it is processed, and following up until it is paid. Maximum Billing provides claims processing and insurance follow-up for medical, mental and behavioral health, and dental practices in twelve states. Our certified billing and coding specialists work inside your practice management system, so every claim stays visible to you.
Schedule a consultation or call 800-820-0364.
What Our Claims Management Services Include
- Charge review: codes, modifiers, units, place of service, and diagnosis pointers checked against the note before the claim is built.
- Claim creation and scrubbing: payer-specific edits applied so preventable errors are fixed before submission, not after a rejection.
- Electronic claims processing: submission through your clearinghouse, with acknowledgment reports reviewed so rejected claims are corrected right away.
- Claim status tracking: claims that are accepted but not paid are checked through payer portals and status inquiries.
- Insurance follow-up: unpaid claims worked by age and dollar amount, before timely filing limits pass.
- Corrected claims and appeals: resubmissions with the right frequency code, and appeals with documentation. See our claims denial management.
- Secondary and tertiary claims: filed once the primary payer’s remittance is posted.
- Insurance collections: persistent follow-up on balances payers owe, including underpaid claims.
Rejections and Denials Are Different Problems
A rejected claim never entered the payer’s system. It failed a clearinghouse or payer front-end edit, such as an invalid member ID or a missing NPI, and has to be corrected and sent again. A denied claim was processed and refused payment, and needs a corrected claim, a reconsideration, or an appeal. Practices that treat the two the same lose time: rejections sit unnoticed because nobody reads the acknowledgment reports, and denials are resubmitted as new claims and denied again as duplicates. Our claims process separates them from the first day.
How We Work Insurance Follow-Up
- Sort the open claims by payer, age, and balance, so the largest and oldest receive attention first.
- Check status through the payer portal or clearinghouse before calling, so each call starts with facts.
- Fix the cause, whether that is missing information, a coordination of benefits question, a credentialing gap, or a request for records.
- Document every action in your system, so anyone on your team can see where a claim stands.
- Escalate to a reconsideration or appeal when a payer will not pay a claim that should be paid.
Our accounts receivable management page explains how we work an aging report in more detail, and our step-by-step guide to the claim submission process covers each stage of a claim.
Claims Processing by Specialty
- Medical: CMS-1500 claims with CPT, HCPCS, and ICD-10-CM codes, modifiers, and prior authorizations. See our medical billing services.
- Mental and behavioral health: psychotherapy and evaluation codes, telehealth modifiers and place of service, and behavioral health plans that process claims separately from the medical plan. See our mental and behavioral health billing services.
- Dental: ADA claims with CDT codes and attachments, and medical claims for dental procedures. See our dental insurance claims processing.
Signs Your Claims Need Better Management
- Clearinghouse rejection reports go unread.
- Claims are sent in weekly batches instead of daily.
- The same denial reasons appear month after month.
- Claims are discovered unpaid only after the filing deadline.
- No one can tell you your clean claim rate.
Why Practices Choose Maximum Billing
- As of 2026, our clients’ claims reach a 91% clean claim rate, and their accounts receivable average 34 days.
- Founded in 2018 by Gina Abrotsky-Salvatore, CPCS, MHT, with more than 20 years of experience in insurance billing and revenue cycle management.
- We work in your software, so you never lose visibility into your claims.
- Every client signs a Business Associate Agreement, and every team member completes HIPAA certification.
- Claims, payment posting, insurance verification, and credentialing handled by one team.
Frequently Asked Questions
What is claims management in medical billing?
It is the process of creating, submitting, tracking, and following up on insurance claims until each one is paid or resolved, including corrections and appeals.
What is the difference between claims processing and claims management?
Claims processing usually means creating and submitting claims. Claims management also covers tracking, insurance follow-up, corrections, and appeals after submission.
Can you take over claims that are already past due?
Yes. We work existing unpaid claims by age and balance, and tell you which can still be collected and which are past the payer’s filing limit.
Do you handle insurance collections?
Yes. We follow up with payers on balances they owe, including underpaid and denied claims.
Talk to Us About Your Claims
Tell us about your payers, your software, and where claims are getting stuck, and we will review your aging report and recent denials with you. Contact us to schedule a consultation, or call 800-820-0364.