Medical billing services
Clean claims do not guarantee full payments. A structured billing cycle does.
The most expensive billing problems rarely appear in a denial report. They happen when a charge is never entered, a payer reimburses less than the contracted rate, or an unpaid claim sits in accounts receivable without follow-up. None of those problems look urgent when they happen, but each one of them leaves part of your revenue uncollected.
To fill this gap, MedHeave manages medical billing as one integrated process instead of a series of disconnected tasks. We verify every payment before posting, take corrective action on denials within a 72-hour window, submit secondary claims promptly, and actively follow-up on unpaid claims until resolution. Every practice we work with is assigned dedicated account managers that stay accountable from charge posting through final payment.
Our operational footprint
These aren't aspirational targets.
These metrics are what we deliver, consistently, across all practices and specialties we work with.
95%+
First-pass rate
24-48 hrs
Submission window
72 hrs
Denial turnaround
Under 40 days
AR Days
Your billing reports are not showing you the full picture.
A practice can be running at full capacity and still fall short on collections. The gap is almost never in how hard your team is working; it is in the stages of the billing cycle that nobody is actively managing. Most practices do not realize there is a billing problem until they audit and realize recovery is a whole new process they need to worry about.
MedHeave manages your complete billing cycle as one connected process. Charge entry, claim scrubbing, eligibility verification, denial management, AR follow-up, and payment reconciliation are all handled by the same team as part of our medical billing services, following documented workflows, with accountability at every stage. When every part of the cycle is owned by the same team, there is no room for revenue to disappear.
Where things go wrong in medical billing
Your billing team can quit on you (not us).
Your billing errors are far more loyal.
Most practices trace their revenue problems back to denied claims. By the time denials arrive, the errors behind it are already days or weeks old. It started somewhere in the billing cycle before submission and was never caught because nobody was looking for it at that stage.
Incomplete documentation stops claims before they start
When a superbill is missing a CPT or diagnosis code, the claim cannot be filed. Every day that documentation sits incomplete is a day that payment is delayed. We follow up with providers weekly on every incomplete superbill, so claims go out within 24 to 48 hours of the date of service.
Claims submitted without scrubbing return as denials
A wrong modifier combination, an incorrect place of service, or a mismatched diagnosis pointer might clear your system, but it cannot go beyond that. By the time the denial comes back, the claim is already days old. We review every claim for NCCI edits, modifier accuracy, diagnosis pointers, and provider information before anything is submitted.
AR without systematic follow-up is revenue lost forever
A claim that goes out and is never followed up on does not stay pending forever. It ages, misses its rework window, and becomes unrecoverable. We follow up on every outstanding balance systematically by payer, aging, and filing deadline, so every recoverable claim is worked before that window shuts.
Calculate your revenue loss
Find out how much your practice is losing to billing gaps every month.
See how much revenue your practice is losing every month to denials, undercoding, and missed follow-ups.
Fill in your details and click Calculate now to see your estimate.
How medical billing services work
Most billing companies just submit claims. We own what happens after.
Medical billing services can never perform well in isolation as a single process. It is a sequence of connected stages where an error at any point affects everything that follows. Most practices manage some of these stages well. The gaps between them are where revenue is lost.
STAGE 01
Before the visit
- Patient registration
- Insurance verification
- Prior authorization
STAGE 02
At the visit
- Provider documentation
- Charge capture
- Superbill completion
STAGE 03
Before submission
- Claim scrubbing
- Eligibility confirmation
- Modifier review
- Diagnosis pointer check
STAGE 04
After submission
- Clearinghouse tracking
- Payer follow-up
- Denial management
- Appeals
STAGE 05
Payment & reconciliation
- EOB review
- Underpayment recovery
- Fee schedule audit
- Patient billing
Our medical billing services
We have a system for every gap your current billing process has.
We work through every stage of your billing cycle with a dedicated team and a documented process, so gaps stop being something you discover after the damage is done.
Charge capture and entry
Every billable service is entered and reconciled against scheduled appointments before a claim goes out. If a service was rendered and not captured in the charge entry, we identify it before it becomes a revenue gap. Every procedure performed is billed accurately.
Claim scrubbing and submission
Every claim is reviewed for NCCI edits, modifier combinations, diagnosis pointers, place of service, and provider information before submission. Claims go out within 24–48 hours of signed encounter notes. Errors that would cause a payer denial are identified and corrected before the claim ever leaves your practice.
Verification of benefits
Before every visit, we confirm that the patient’s insurance is active on the date of service, verify what the payer covers, and establish what the patient owes. Catching eligibility issues before the appointment eliminates the denials that take weeks to resolve once a claim is out.
Denial management and appeals
Denials are identified through ERA responses and worked within 72 hours. Each denial is reviewed for reason, eligibility, and claim accuracy. Correctable errors are fixed and resubmitted immediately. Claims that are correct are appealed with a full package, cover letter, HCFA, clearinghouse proof of timely submission, and all supporting EOBs, written and managed entirely in-house.
Accounts receivable follow-up
Every outstanding balance is an active follow-up item, not a line on a monthly report. We prioritize by payer, aging bucket, and filing deadline so nothing ages past its rework window without action already in motion.
Payment posting and EOB reconciliation
Underpayments that pass through without verification compound over time and reduce your net collections permanently. At MedHeave, every payment is posted and checked against your contracted fee schedule before it is accepted. When a payer pays below the contracted rate, we flag it before posting and initiate a review.
Underpayment recovery
For in-network claims paid below the contracted rate, we contact the payer with documentation and request reprocessing. For out-of-network claims, we negotiate directly to recover the maximum reimbursement. We track every underpayment case and follow up until the correct amount is received or every option is exhausted.
Patient billing and statements
We collect copays at appointment confirmation. Coinsurance and deductible balances are billed after each insurance response with clear, accurate statements. If the practice allows direct patient billing, we handle it. If not, statements are prepared and sent to the practice for distribution.
Additional documentation management
When a payer requests supporting records before releasing payment, we identify what is needed, pull what is already in the system, and collect anything additional from the practice. Records go to the payer through their required channel, and the claim is tracked until a determination is received. A documentation request does not stall the claim; it becomes the next active step in the process.
Medical billing services by network status
Getting paid and getting paid right are two different things. Where do you stand?
Your network status with each payer determines the billing workflow, the payment review process, and what happens when reimbursement falls short.
MedHeave manages all aspects with separate protocols, so no payer network
gets treated like the other.
In-network claims are audited against your contracted rate
Payers do not always pay what the contract says. They apply outdated fee schedules, process modifiers incorrectly, and send short payments that post and close without anyone reviewing them. We audit every in-network ERA against your contracted rate before it is posted. When a payment is short, it goes back to the payer as a dispute with documentation. When a payer is consistently underpaying across claims, we surface that with the data behind it so the practice can decide what to do about the contract.
Out-of-network reimbursement is negotiated, not just accepted
Out-of-network claims return a payment that reflects the payer’s initial determination, not a final agreed-upon amount. We negotiate directly with the payer based on the claim documentation, the billed codes, and the payer’s reimbursement patterns. Practices that accept out-of-network payments without negotiating are consistently leaving money behind, and there is no automatic process that recovers it after the account is closed.
Telehealth billing follows office rules with one additional requirement
In-network and out-of-network billing rules that apply to office visits apply equally to telehealth. The additional requirement is licensure. A provider seeing a patient over telehealth who is located in another state must hold a license in that state to bill for that visit. If they do not, the patient pays out of pocket, and the claim has no path to insurance reimbursement. We flag that before the claim is built, not after it comes back unpayable.
COB claims require the right payer order and the right documentation
When a patient has multiple insurance plans, the payer order has to be confirmed before the first claim goes out. We determine primary and secondary, contact the patient when there is ambiguity, and coordinate directly with insurers when the order is contested. When a payer reverses a previously settled claim months later because they have determined another insurer is primary, we file the appeal with the reversal letter, the original clearinghouse submission proof, and the primary payment record. The appeal is only possible because the documentation was maintained throughout.
Specialties we serve
Your specialty has its own billing rules that we have mastered.
We do not onboard your specialty and then learn it. We come in already knowing where the billing gaps are and how to close them.
Behavioral health
In behavioral health, missing eligibility or session tracking can cost several visits, not just one. We stay ahead of authorization limits, benefit caps, telehealth rules, and co-pay terms so billing stays steady through care.
Podiatry
For podiatry billing, we make sure modifiers like 25 and RT/LT are accurate, services align with global periods and payer edits, and orthotics always meet payer-specific authorization and DME requirements before claims go out.
Urgent care
We handle urgent care billing across walk-ins, diagnostics, and procedures. From there, we track payor coding rules, facility contracts, prior authorizations, and eligibility checks so claims never get delayed, cut, or denied.
Orthopedic
We handle orthopedic billing, making sure procedures get authorized upfront and modifiers like LT/RT and bilateral get applied well. Surgical cases with implants are coded and billed the way payers actually expect for payment.
Cardiology
Cardiology billing often triggers NCCI edit denials, bundling issues, and global period violations when E/M services and procedures are billed together. We manage coding and modifier logic to reduce denials and boost payments.
DME
DME billing is handled by aligning orders, documentation, and delivery timelines with payer rules. We apply HCPCS coding, manage capped rentals, and enforce refill limits so claims are never denied for missing paperwork today.
Pediatrics
In pediatrics, we handle well visits and immunizations, making sure vaccine administration and VFC eligibility are correct. Age-based coding stays accurate as well, so nothing gets missed, underbilled, or delayed at any visit.
Anesthesia
The accuracy of anesthesia billing depends on capturing start and stop times correctly. We ensure precise time capture, apply base units and modifiers, and handle medical direction & concurrency so each unit is billed right.
Don’t see your specialty? We likely work in it.
Where errors start in medical billing services
Most errors are not just billing errors. They are process gaps.
Every denial your team works is three new claims that did not get filed. The same errors repeat every month because the source never gets addressed, and the cost is not just the one claim you are fixing. It is everything that did not move forward while your team was fixing it.
STAGE 01
It starts at the front desk
Incorrect insurance information, missing authorizations, and unverified coverage collected at intake follow the claim all the way to submission. A patient whose benefits were never confirmed properly will generate a denial that looks like a billing error but originated at registration. Our real-time eligibility checks at the point of scheduling identify these before the encounter ever happens.
STAGE 02
It continues with the provider note
An incomplete superbill stops the claim before it starts. A note that does not support the code billed creates audit exposure and opens the door to payer recoupment. We follow up with providers weekly on incomplete superbills and flag documentation gaps before the claim is built, so your coding is supported, and your revenue is protected in the event of a payer audit.
STAGE 03
It compounds at coding
A wrong modifier, an unsupported diagnosis pointer, or a code that requires documentation the note does not contain will pass through your system and fail at the payer. These errors do not announce themselves. They clear the clearinghouse and come back as denials ten days later. We run pre-submission audits against NCCI edits, modifier combinations, and diagnosis pointer alignment to catch them before they go out.
STAGE 04
It reaches submission
Formatting issues, missing provider information, incorrect place of service, and date of service discrepancies are submission-level errors that a scrubbing process is designed to catch. When scrubbing is skipped or treated as a checkbox, these errors reach the payer. We review every claim against these parameters before submission. A 90% or higher first-pass acceptance rate is the result of that review, not a feature of the software.
STAGE 05
And it does not stop at payment
Errors do not stop at submission. A payment that posts without being checked against the fee schedule, a secondary claim that never goes out after the primary pays, a patient balance that is never billed after the ERA arrives; these are errors that happen after the claim is processed, and they do not generate denials. We identify them before they turn into revenue loss that only surfaces in an audit.
Our medical billing process
From onboarding to a fully running revenue cycle.
Most practices worry about what happens to their revenue during a transition.
At MedHeave, we have built our onboarding around making sure nothing is lost in that window.
Audit your current billing
Before working on any claims, we pull a full aging report, identify every open and outstanding balance, and review your current EHR and billing platform. We document your payer mix, build payer-specific billing guideline sheets for your practice, and assign two dedicated contacts who will manage your account going forward. Nothing moves until the setup is accurate and complete.
Charge entry and encounter auditing
Every scheduled appointment is reconciled against what was billed in your EHR. When a superbill is incomplete or a provider note is unsigned, we flag it and follow up with the provider directly. Claims are submitted within 24-48 hours of a signed encounter. Providers are notified weekly of any unsigned notes or missing documentation holding up submission.
Claim scrubbing and submission
Every claim is reviewed for NCCI edits, modifier accuracy, place of service, date of service, diagnosis pointer alignment, and rendering and billing provider information. This level of scrutiny allows us to maintain the 90%+ first-pass acceptance rate. Claims that pass this review go to the payer the same day.
Denial management and appeals
Every denial is worked within 72 hours. We review the denial reason, verify eligibility and claim details, and determine whether the issue is on our side or the payer's. If correction is needed, the claim is fixed and resubmitted. If the claim is correct, we contact the payer, provide supporting documentation, and request reprocessing. Appeals are written in-house with a cover letter, HCFA, clearinghouse submission proof, and all supporting EOBs.
AR follow-up and aging management
Open balance is tracked by payer, aging, and filing deadline. We follow up on outstanding claims systematically before any rework window closes. The AR target is under 40 days, and every account is worked to that standard. No claims ages out because they were too small to prioritize.
Payment posting and reconciliation
Every ERA and EOB is reviewed against your contracted fee schedule before it is posted. In-network underpayments are disputed with the payer. Out-of-network payments are negotiated directly. Secondary claims go out after the primary posts. Patient balances are billed after the ERA is received. The account does not close until payment is confirmed correct and every downstream billing step is complete.
Why MedHeave
We don’t process claims and call it a day. We make sure they get paid.
Most billing services measure themselves by submission volume. MedHeave measures on what actually gets collected, what gets caught before it becomes a problem, and what gets recovered when a payer does not pay correctly.
Two dedicated account managers on every account
Every practice gets two dedicated contacts who know the account, know the payer mix, and are reachable directly. There is no rotating support queue, no ticket system, and no explaining the same context to a different person every time something needs attention.
Payer-specific billing guidelines built for your practice
We document the billing rules for every payer your practice works with. Accepted codes, modifier requirements, documentation standards, and payer-specific quirks are recorded and applied to every claim. When a payer changes a rule, the guideline sheet gets updated. We build claims against what the payer actually requires, not against a generic billing template.
Underpayments get treated as a contract problem, not a billing one
When the same payer is consistently paying below the rate and confirms the payments are per their contracted schedule, the problem is not the claim; it is the contract. We document the revenue impact across every affected claim and bring it to the practice with the data behind it. The decision to renegotiate or terminate belongs to the practice. We make sure it is made with the full picture.
When underpayments trace back to the contract, we bring the data to terminate or renegotiate
Most billing companies dispute individual underpayments and stop there. When a payer confirms their payments are per their contracted schedule and the contract itself is the problem, we document the full revenue impact across every affected claim and bring it to the practice as a contract-level issue. We have helped practices terminate and renegotiate contracts on this basis. That outcome only happens when someone is tracking payments systematically enough to see the pattern.
Appeals are built around clearinghouse timestamps, not just claim accuracy
When a timely filing denial occurs, the appeal is built around the original clearinghouse submission proof, establishing that the claim was filed on time regardless of when the denial arrived. This is only possible because submission records are maintained throughout the cycle, not retrieved after the fact.
Documented SOPs behind every step
Every billing function at MedHeave runs under documented standard operating procedures with supervisor oversight on every account. When something goes wrong, there is a documented workflow that traces it back to the source. The answer is never that the person who handled it is no longer available.
Performance monitoring
Every billing cycle has room for errors. This is how we handle yours.
A billing process that only works when everything goes smoothly is not a billing process; it is a submission service. MedHeave is built to handle what happens when payers reverse payments, claims age toward deadlines, and documentation requests arrive mid-cycle.
Clean claim denied
We review the denial reason, pull the original eligibility verification, and determine whether the issue is on the payer’s side or ours. Incorrect denials go back to the payer with documentation and a reprocessing request. Correctable claims are fixed and resubmitted.
Every denial is worked within 72 hours and closed with a documented resolution.
Payment reversed
The appeal goes out with the reversal letter, the original clearinghouse submission proof, and the full primary payment record. If the reversal is valid, we reroute billing through the correct primary and follow the COB process through to secondary. You are notified of what happened and what the recovery path looks like before we start working on it.
Filing deadline at risk
Claims go out daily, and providers are notified weekly of anything holding up submission. When a claim reaches risk despite those controls, it is escalated and submitted with available documentation, while the rest is gathered. If a timely filing denial occurs, the appeal is built around the original clearinghouse timestamp, establishing that the claim was filed on time.
Consistent underpayments
Every denied claim is documented, each payment is compared against the contracted fee schedule, and the discrepancy record goes to the payer as a dispute. When a payer confirms their payments are per their contracted schedule and the contract itself is the problem, we bring the full revenue impact and documentation to you. That decision belongs at the contract level, and we make sure it is made with the right information.
Documentation requested
We identify what is needed, pull what is already on file, and request anything additional from the practice. Supporting records go to the payer through their required channel, and the claim is tracked until payment or a final determination is received. A documentation request does not pause the process; it becomes the next step in it.
Performance monitoring
If something is underperforming, we will know it before you.
A billing cycle that is quietly underperforming does not announce itself. It shows up weeks later as a revenue gap with no obvious cause. We track the right metrics on a rolling basis so the cause is identified and corrected before the gap compounds.
01
DETECT
Every gap gets traced to its source
When current performance falls below the prior six-month period, we identify whether the issue is originating on the charges side or the payments side before presenting anything. A charge problem means services are not being captured or billed correctly. A payment problem means claims are not returning at expected rates due to denials, underpayments, or unworked AR. The diagnosis determines the fix.
02
REPORT
Consistent reporting on every account
Every practice receives weekly charge and payment reports, monthly AR summaries, and a six-month rolling performance comparison. When the numbers are where they should be, you are updated. When they are not, the monitoring cadence is what surfaces it before it becomes a cash flow conversation.
03
RESOLVE
You receive a plan, not a review
When we identify underperformance, we bring you the source, the part of the cycle it came from, and what is being done to correct it. The conversation is not about what went wrong. It is about what is already being fixed and what the practice needs to do on its end, if anything, to support that correction.
FAQs
Questions providers like you often asks us about medical billing services.
Most providers have the same questions before partnering with us for medical billing services. Here is what we tell them.
How quickly do you submit claims after a patient visit?
We submit claims within 24-48 hours of the provider signing the encounter notes. If notes are unsigned or documentation is incomplete, we follow up with the provider directly so nothing is delayed.
What happens when a claim is denied?
We review the denial reason, verify eligibility, and check the claim details. If the error is on our end, we correct and resubmit immediately. If the claim is correct, we contact the payer, provide supporting documentation, and follow up until it is resolved.
How do you handle underpayments?
We review every EOB against your contracted fee schedule. If a payment is below the agreed rate, we contact the payer and request a review. For out-of-network claims, we negotiate directly with the payer to recover the maximum reimbursement possible.
What happens to our existing claims if we switch to MedHeave for medical billing services?
We start by pulling your full aging report and identifying every outstanding and unpaid claim. If you want us to work your backlog, we do. We take corrective action, resubmit where needed, and follow up until payments are received.
How do RCM companies manage billing across multiple insurance plans for the same patient?
We determine which payer is primary and which is secondary, confirm the order of benefits with the patient, bill the primary first, and submit the remaining balance to the secondary. We monitor both claims until payment is received from each.
Can a medical billing company work with my existing EHR?
MedHeave works across Epic, Tebra, OfficeAlly, Charm EHR, Therapy Notes, Jane App, Kalix, Simple Practice, Chorus, ModMed, NextGen, and OptiMantra, among others. For new practices without an existing system, billing software is configured from the ground up as part of onboarding.
How do medical billing companies communicate billing updates with the practice?
Through email and calls. We provide regular updates on billing activity, payments received, and outstanding AR so you are never left wondering where things stand.
How do medical billing companies handle prior authorizations?
We manage auth requests, track approvals, and handle retro auths when needed. If an auth is denied, we evaluate every appeal option before anything is written off.
How do I know MedHeave is actually working as part of my team and not just as an outside vendor?
For practices that prefer it, we operate under a practice-provided email domain, so all communication with your patients and staff comes from an address they recognize. Combined with two dedicated contacts who know your account, the experience on your end is a billing team that is part of the practice, not a medical billing service running in the background.
How do I know if my medical billing company is performing well?
The clearest indicators are your first-pass claim rate, days in AR, and net collection rate. A first-pass rate below 90 percent means errors are reaching the payer that should have been caught before submission. Days in AR above 40 signal claims are not being followed up on systematically. Beyond the numbers, your billing company should be providing weekly charge and payment reports, monthly AR summaries, and a six-month rolling performance comparison. If you are only hearing about problems after they have already affected cash flow, that is a process gap, not a reporting delay.
What happens to my existing claims if I switch billing companies?
Before any claim is touched, a full aging report is pulled to identify every open and outstanding balance. Every claim still within its filing window is identified and prioritized. Outstanding balances are worked, corrective action is taken where needed, claims are resubmitted where applicable, and follow-up continues until payments are received. Nothing in the backlog is written off without being worked on first.
What is a good first-pass claim rate?
90 percent or higher. That is the benchmark MedHeave holds itself to. Every claim is reviewed against NCCI edits, modifier combinations, diagnosis pointers, place of service, and provider information before it reaches the payer because that review is what keeps the number where it is.
How do medical billing companies handle denied claims?
At MedHeave, every denial is worked within 72 hours of identification. The denial reason is reviewed, eligibility is verified, and the claim is checked for accuracy. If the error is correctable, the claim is fixed and resubmitted immediately. If the claim was submitted correctly, the payer is contacted, and an appeal is filed in-house with a full package including a cover letter, HCFA, clearinghouse proof of timely submission, and all supporting EOBs. No appeals are outsourced to a third party.
If your billing has gaps, they’re already affecting collections.
You just haven’t seen it yet.
Before we onboard you or take over your billing, we perform an audit of your current setup to identify exactly where you’re losing revenue.
