BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM Medical coding
🟢 Claims Management Services
Maximizing Reimbursements with Efficient Claims Processing
Our streamlined claims management handles everything—from submission to payout. Level up your revenue flow and keep your practice moving forward
Schedule a Call98%
First-Pass Claim Acceptance Rate
12 Days
Average Claim Processing Time
4%
Claim Denial Rate
Overview
Seamless Claims Processing for Faster Reimbursements
Our Claims Management Services ensure accurate submissions, timely reimbursements, and compliance while optimizing processing and supporting patient transparency.
Claims Submission & Processing
We manage electronic (EDI 837P/I) and paper claim submissions, ensuring they meet payer requirements and coding guidelines (ICD-10, CPT, HCPCS). Our rigorous claim-scrubbing process reduces errors and prevents unnecessary denials.
Insurance Eligibility & Pre-Authorization
Before submitting claims, we verify patient coverage through real-time eligibility checks (270/271 transactions) and obtain prior authorizations to ensure compliance with insurance policies and reduce denials due to missing approvals.
Denial Management & Appeals
We track and analyze denied or rejected claims, providing strategies for root cause analysis and resubmission. Our team manages appeals based on Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) to secure proper reimbursements.
Payment Posting & Reconciliation
We use Electronic Remittance Advice (ERA 835) and manual payment processing to ensure accurate payment posting. Our reconciliation process helps identify underpayments, overpayments, and outstanding balances, ensuring financial accuracy.
Patient Billing & Financial Support
We provide clear EOBs, detailed patient statements, and financial counseling to help patients understand their medical bills and available payment options.
Operations
Efficient & Transparent Claims Processing from Start to Finish
Our structured claims management operations integrate with EHR/EMR systems, clearinghouses, and payer networks, ensuring efficient billing, reduced claim denials, and optimized revenue collection.
Automated Claim Scrubbing & Validation
We verify claims for coding accuracy, missing information, and compliance with National Correct Coding Initiative (NCCI) edits, minimizing errors before submission.
Real-Time Payer Communication & Status Tracking
Through Electronic Data Interchange (EDI 276/277 transactions), we track claim status in real-time, ensuring proactive follow-ups on pending or delayed claims.
Accounts Receivable (A/R) Management
We conduct aging analysis, payer follow-ups, and timely resubmissions to maintain low Days Sales Outstanding (DSO) and maximize collections.
Regulatory Compliance & Audit Readiness
Our services adhere to HIPAA, CMS, and payer-specific guidelines, ensuring compliance with Medicare, Medicaid, and commercial insurance regulations to avoid audits and penalties.
Comprehensive Reporting & Revenue Insights
We provide customized reports, denial trend analysis, and financial performance metrics, empowering healthcare providers with data-driven decision-making for revenue cycle optimization.
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have securely received your patient and encounter data, we code, review, and submit claims to payers. We manage appeals and denials, track payments, and provide regular updates. Our process is designed to be efficient and transparent.
Our certified coders and billing specialists review every claim carefully. We use quality‑control checks, regular coding audits, and payer‑specific validation to reduce coding errors and the risk of denials.
Our denial‑management team reviews each denied claim to identify root causes. We correct issues, resubmit claims promptly, and, when needed, pursue appeals with payers to maximize reimbursement.
We offer flexible pricing tailored to client needs — including fixed fees, per‑claim pricing, or percentage‑of‑collections models depending on volume and services required. Contact us for a custom quote.
Yes. We specialize in seamless transitions from in‑house systems or other vendors. To ensure secure data migration, our team works closely with you and provides training as needed.
Resources
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