CLAIMS PROCESSING SERVICES

Medical Claims Processing From Charge Entry to Resolution

SkyLine MB manages each claim from the encounter to the final balance — charge entry, scrubbing, submission, payer response, posting and secondary billing — until the account makes sense.

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End to end

Encounter to final balance

Every status

Paid, pending, denied

Monthly

Claims & A/R review

No lock-in

Flexible agreement

Every claim followed to a resolved balance

OVERVIEW

What Is Medical Claims Processing?

Medical claims processing is every step between a patient visit and a resolved account: turning the encounter into a claim, sending it to the right payer, handling the payer’s response and reconciling what’s left.

A claim isn’t finished when it’s submitted. SkyLine MB follows paid, partially paid, pending and denied claims, posts payments, bills secondary coverage and makes sure the remaining balance is correct.

Who it's for

Practices with claim backlogs or slow payment cycles

What's included

Charges, scrubbing, submission, follow-up, posting

How it's priced

% of collections, per claim, or monthly

Time to go live

Plan around 2–4 weeks; access and payer readiness affect timing

THE CHALLENGE

Why Claims Get Stuck Between Visit and Payment

Most claims don’t fail at one step — they stall between steps when no one owns the handoff.

12 months

Medicare generally requires claims to be filed within 12 months of the date of service. — CMS

41%

of surveyed providers reported claim-denial rates of 10% or more. — Experian Health, 2025

Charge entry delays

Charges wait for documentation, pushing the whole cycle back.

Wrong payer or data

Claims sent to the wrong payer or with mismatched subscriber details.

Pending claims

Claims wait for information no one sends.

Partial payments

Underpaid lines close in the system without review.

Missed secondary claims

Balances never billed to the secondary plan.

Unreconciled balances

Patient balances don’t match what payers actually allowed.

A claim isn’t resolved until the remaining balance makes sense. We follow every claim to that point.

WHAT'S INCLUDED

Medical Claims Processing Services We Provide

Scope claims processing around your volume and systems. We agree handoffs with your front desk and providers before go-live.

Charge Entry

Charges entered from documentation with codes and modifiers.

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Claim Scrubbing

Payer and NCCI edits checked before release.

Claim Submission

Claims sent electronically to the correct payer.

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Status Follow-Up

Pending claims checked and payer requests answered.

Payment Posting

ERA/EOB payments and adjustments posted and reviewed.

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Underpayment Review

Partial payments compared with expected amounts.

Secondary Claims

Secondary and tertiary claims billed with primary EOBs.

Denial Handling

Denied claims corrected or appealed when supported.

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Also available:

HOW IT WORKS

Our Claims Processing Workflow, Step by Step

Six stages from encounter to resolved balance. During onboarding we agree system access, charge handoffs and how open claims are taken over.

STEP 01

Encounter to charge

Documentation reviewed and charges entered with codes.

STEP 02

Scrub & validate

Claims checked for payer, coding and data errors.

STEP 03

Submit

Claims sent to the right payer through the clearinghouse.

STEP 04

Payer response

Paid, partial, pending and denied claims each handled.

STEP 05

Post & reconcile

Payments posted and balances checked against the allowed amount.

STEP 06

Secondary & resolve

Remaining balances billed to secondary or patient, then closed.

IN-HOUSE VS. OUTSOURCED

Outsourced Claims Processing vs. In-House Billing

What it takes to move every claim from visit to resolution.

Compare staffing, scope and oversight before choosing a model
What matters	In-house	SkyLine MB (outsourced)
Staff & cost	Billers, training and software	Agreed fee for the contracted scope
Coverage	Backlogs when staff are out	Coverage agreed with your contact
Scrubbing	Basic system edits	Payer and NCCI edits reviewed
Pending claims	Checked when someone remembers	Followed on a set schedule
Partial payments	Accepted without review	Compared with expected amounts
Secondary billing	Often missed	Billed with the primary EOB
Reporting	Claims counts only	Monthly claims and A/R review
Security responsibilities	Practice safeguards and access	Shared responsibilities, a BAA and agreed access

Claims processing covers the whole claim. If you only need help getting claims out the door, see our claims submission services.

PRICING

How Much Do Medical Claims Processing Services Cost?

Claims processing is usually priced as a percentage of collections, per claim or as a monthly fee.

Percentage of collections

A share of what is collected for the agreed scope. Confirm what counts as a collection and which tasks are included.

Quoted as a percentage of collections

Best for ongoing billing work

Per-claim fee

A fee for each claim within an agreed scope. Confirm whether corrections, appeals and follow-up are included before comparing quotes.

Rate depends on claim complexity

Best for predictable claim mix

Flat monthly fee

A fixed monthly price for an agreed scope and volume. Easy to budget; the scope must be written down clearly.

Varies by providers and scope

Best for stable, predictable volume

HOW SKYLINE MB PRICES

One clear rate, quoted after a claims review

Your quote reflects claim volume, payer mix, specialty and how much open work we take over. We confirm scope and handoffs in writing before you start.

TRANSPARENT REPORTING

The Claims Processing KPIs We Report Every Month

Monthly reporting shows how claims move through each stage. We agree definitions and reporting periods during onboarding.

Clean claim rate

Acceptance

Initial claims accepted without correction ÷ initial claims submitted.

Charge lag

Days to bill

Average days from date of service to claim submission.

Denial rate

Payer denials

Claims denied ÷ claims adjudicated in the period.

Days in A/R

A/R ÷ charges

Total A/R ÷ average daily gross charges over the agreed lookback period.

Pending claims

No response

Claims with no payer decision after the agreed number of days.

Secondary billed

Follow-through

Eligible secondary claims billed ÷ secondary claims due.

Definitions and reporting periods are agreed during onboarding. Payer processing is outside our control; no payment outcome is guaranteed.

SPECIALTIES

Claims Processing for 20+ Specialties

Every specialty has its own codes, modifiers and payer rules. Pick yours to see how we support it.

EHR & PM SYSTEMS

Works Inside Your Current EHR

We assess your current EHR and practice-management workflow first, then agree access and handoffs with your team.

Using another system? Tell us which platform you use so we can confirm compatibility and access requirements.

TECHNOLOGY

Automated Claim Checks With Human Review

Claim scrubbers catch format, coding and payer-rule errors in seconds. But many issues need a person — reading a payer response, checking a partial payment or fixing a subscriber mismatch.

COMPLIANCE & SECURITY

HIPAA-Compliant Claims Processing

Claims carry PHI at every step. We sign a Business Associate Agreement and use role-based, audited access to your systems.

FREE CLAIMS REVIEW

Not sure where your claims are stalling?

We review recent claims by status, payer and age, then show you where claims are getting stuck and which fixes would speed up payment.

What happens next: send your practice details, speak with a specialist, then agree a secure way to share anything needed for the review. Do not send patient records through this enquiry form.

CLIENT STORIES

What Practices Say About SkyLine MB

Independent practices, specialty groups and clinics trust us with the work that keeps revenue moving.

Our denials used to sit for weeks. Now every denial has an owner, a reason code and a next step — and we see it all in one monthly review. It's the first time billing hasn't felt like a black box.

Therapy billing has so many visit limits and modifier rules. The team caught authorization gaps before they turned into denials, and our front desk finally stopped chasing payers.

Switching billing partners scared us, but onboarding was organized from day one. They worked inside our existing EHR, so my staff didn't have to learn anything new.

Telehealth codes, payer-specific policies, credentialing — they handled all of it. Having one billing manager who actually knows our practice makes a real difference.

We get clear answers on why a claim was underpaid and what's being done about it. The monthly KPI call is something our physicians now look forward to.

High visit volume means small errors add up fast. Clean claims go out quickly and the A/R follow-up is consistent — no more old balances quietly aging out.

FAQ

Frequently Asked Questions About Medical Claims Processing

Straight answers to what practices ask before choosing a billing partner.

Still have a question?

Talk to a billing specialist — no sales pressure.

What are medical claims processing services?

Medical claims processing services handle the administrative billing work involved in preparing, submitting, tracking, correcting, and resolving healthcare insurance claims. Depending on the service scope, they may also include denial management, payment posting, secondary billing, and accounts receivable follow-up.

Is medical claims processing the same as claims submission?

No. Claims submission focuses on preparing and transmitting claims to insurance payers and managing related submission responses. Full medical claims processing covers a broader lifecycle, including payer adjudication follow-up, payment processing, denials, and remaining account balances.

Related Services

Claims Submission

Fast, accurate electronic filing.

Learn more →

Payment Posting

ERA/EOB payments posted and reconciled.

Learn more →

A/R Management

Aging claims worked to payment.

Learn more →