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A Deeper Understanding Of Electronic Claims In Medical Billing

An electronic claim is a new norm in the medical billing industry. It is time to transition from manually filed claims to electronic claims and join the industry standard.

Electronic Claims

As obvious from its name, an electronic claim is a medical claim generated digitally using medical software and generally in the software. Doctors are eventually adapting to this norm; however, an electronic claim can be created and filed by doctors themselves or can be handled by outsourced medical billing services. Picking the right service for your practice can immediately streamline the process, and you can proceed with smoothly submitting claims electronically to the payers. 

Advantages of Electronic Claims

In 2013, the cooperation of the American Medical Association (AMA) and the Connecticut State Medical Society resulted in the development of an educational resource that highlighted the advantages of using electronic claims for medical billing. The following are the key benefits of electronic claims:

Claim scrubbing

Manual claim scrubbing always has room for errors. Even after double-checking claims, experts medical billers and coders can leave a trace of missed detail. Such errors are better identified by automated claim scrubbers that follow electronic medical claims. AR management services and medical billing companies use automated claim scrubbers and encourage physicians to do the same. With these claim scrubbers, there is a high chance that the payer will receive an accurate claim, eliminating the risk of claim denial.

Saves times

Submitting claims in hardcopy form is a time-consuming process. It includes multiple steps – manually completing the form, reviewing it, printing a copy, and delivering it to the required insurance company. With electronic claims, all lengthy steps can be skipped, and the errors can be minimised. Quicker and error-free claims improve cash flow and reduce claim rejections.

Cuts back resources

The creation and submission of manual medical claims demand staff and a budget for postage. You can save both by using electronic claims. According to research, transferring from manual to electronic billing can save you up to 60% of the total cost. 

Clearinghouses incorporation

Delivering claims via mail can be prone to various potential difficulties – for instance, the claims can be delivered to the incorrect address, or they can get lost. With electronic billing of claims, the claims are directed to the correct address and are immediately received by the payers.

Claim tracking

Claims sent via mail are difficult or impossible to track. The only assurance you get regarding the claim being delivered to the desired address is the payer updating you with its acceptance status. Electronic claims give you the benefit of real-time tracking.

Quicker payments and reimbursements

Electronic claims can save you the time wasted in delivering the claim to its destination and waiting for payment. They give an ‘INSTANT’ output – instant claim submission and reimbursement. Filing claims through electronic billing eliminates any delays that may occur in the billing cycle.

Streamlined AR

The smooth flow of every step of the billing process with electronic claims allows the accounts receivable (AR) to be updated at all times. The exclusion of held-up revenue streamlines the AR of the practice.

Submission of Electronic Claims

Electronic claims submission in medical billing can be done in two ways. The main difference is the number of payers you are associated with.

Self-service electronic claims

Any electronic claim creation and submission handled in-house is considered self-service. Self-service claim creation can be done solely by the practitioner or the in-house billing team (partially self-service). In the case of a few payers, the self-service model may be suitable and manageable. However, the process can get complicated if the practice deals with multiple payers. This difficulty occurs due to the software requirements of the payer. Every payer specifies software that can be used for claim creation. A practice dealing with multiple payers can turn to integrated clearinghouses for reduced billing complexity.

Full-service electronic claims

Outsourced medical billing includes the complete handling of electronic claims. This is known as full-service electronic claims. Medical billing companies require the patient demographics and a summary of the performed services to create an electronic claim. The experts encode this information into CPT and ICD-10 codes for insurance companies. The claims are then run through the claim scrubber, increasing the claims’ accuracy. Once the claims are cleared, they are received by the payer and reimbursed.

This approach is highly-suitable for practices connected with several payers and has a larger patient flow. Outsourced medical billing services are working effectively to increase the revenue cycle of practices and have reported positive outcomes.


Electronic claims have proved efficient and effective in the medical billing industry. The introduction of electronic claims has satisfied medical practices, patients, and payers, which can be considered a great achievement. With electronic claims, practices save time, cost, and resources. Moreover, practices have experienced higher revenue, streamlined AR, and better claim tracking.

HBC Editors
HBC Editorshttp://www.healthcarebusinessclub.com
HBC editors are a group of healthcare business professionals from diversified backgrounds. At HBC, we present the latest business news, tips, trending topics, interviews in healthcare business field, HBC editors are expanding day by day to cover most of the topics in the middle east and Africa, and other international regions.

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