The transition from charge entry to claims submission marks one of the most critical phases of the revenue cycle management process. This is where the rubber meets the road. If claims are not submitted cleanly and efficiently, even strong coding practices cannot guarantee the reimbursement. Claim submission and management are the operational engines that drive timely payments, reduce denials, and keep downstream workflows moving smoothly.
What Is Claim Submission & Management?
Claim submission is the process of sending completed, coded claims to payors, either electronically through a clearinghouse or directly via payor portals. Claim management refers to everything that happens after submissions: tracking, status monitoring, and follow-up until the claim is adjudicated and paid.
The process includes:
- Scrubbing claims for errors and missing information
- Submitting claims electronically (EDI) or via paper when required
- Monitoring claim status through clearinghouses and payor portals
- Resolving rejections (before adjudication) and resubmitting quickly
- Tracking payor responses, remittance advice, and payment timelines
Why Claim Management Matters
Even small delays in submission or follow-up can significantly increase days in A/R and slow cash flow. Worse, if rejections are not addressed promptly, timely filing deadlines may be missed, resulting in permanent revenue loss.
Efficient claim management helps ensure:
- Faster payment through clean claims, first-pass claims
- Fewer rejections and denials, reducing rework
- Improved visibility into cash flow and payor performance
- Compliance with payor and CMS timelines and formats
- Better reporting for forecasting and revenue planning
Common Claim Submission & Management Issues
| Issue | Cause | Impact |
|---|---|---|
| Rejected claims | Formatting errors, invalid codes, missing data | Payment delays and resubmissions |
| Missing deadlines | Poor tracking or batching delays | Lost revenue due to timely filing violations |
| No follow-up | Staffing gaps or system limitations | Claims stuck in limbo |
| Inconsistent payor rules | Varying formats and requirements | Increased manual work and denials |
Best Practices for Clean Claim Submission
To strengthen internal claim submission processes, consider the following best practices:
- Use pre-submission edits and claim scrubbers to catch errors early
- Track every claim in a centralized system or clearinghouse dashboard
- Establish internal standards to submit claims daily, not weekly
- Flag and resolve rejections quickly (ideally within 24 hours)
- Segment claims by payor and apply payor-specific rules and logic
Gryphon’s Approach to Claim Submission & Management
At Gryphon Healthcare, we treat claim submission as a mission-critical function that demands speed, precision, and accountability.
Our approach includes:
- Advance claim scrubbing tools to ensure payor-specific compliance before submission
- Automated EDI submission integrated with clearinghouses and direct payor connections
- Real-time tracking dashboards for full claim visibility
- Dedicated follow-up teams that pursue rejections and ensure timely resubmission
- Audit trails and performance reporting to identify trends and prevent future issues
Because claim submission is part of our comprehensive RCM strategy, it integrates seamlessly with coding, denial management, and collections.
Coding & Charge Entry: Ensuring Accuracy for Optimal Reimbursement