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Claims Management

Claims Submitted Cleanly, Followed Closely, Resolved Completely

Getwell Healthcare Solutions manages the claim lifecycle from scrubbing and submission to follow-up, denials and appeals, with reporting that shows what is paid, pending and at risk.

Request a Consultation Denial Management
  • Pre-submission claim scrubbing
  • Scheduled claim status follow-up
  • Denials tracked by root cause
Claims specialist reviewing claim forms and a laptop dashboard
Stethoscope on a laptop used for electronic claim submission

Claims Submission

Getting Claims Right the First Time

Every claim is checked before it leaves: patient and subscriber data, payer IDs, rendering and billing NPIs, place of service, CPT/HCPCS and ICD-10 pairing, modifiers and units. Claims are then submitted electronically through your clearinghouse.

Clearinghouse and payer acknowledgments are reviewed daily so rejected claims are corrected and resent quickly, well inside timely filing limits.

  • Claim scrubbing against payer and clearinghouse edits
  • Electronic submission (837P / 837I as applicable)
  • Rejection review and resubmission
  • Secondary and crossover claims
  • Corrected claims and voids when needed

Claims Follow-Up

A Defined Follow-Up Routine

Claims that are not rejected are not necessarily moving. We check status on a set schedule.

  1. Acknowledgment check

    Confirm the payer accepted the claim into its system.

  2. Status review

    Check claim status through payer portals or electronic status inquiries.

  3. Payer contact

    Call or message payers on claims with no response or unclear status.

  4. Resolve and document

    Provide requested information, resubmit when needed, and note every action on the account.

  5. Escalate

    Move stalled or high-balance claims to appeal, reconsideration or escalation as appropriate.

Denial Management

Denial Management and Appeals

We sort denials by reason so each one reaches the right fix, and so recurring causes can be addressed upstream.

Eligibility and coverage

Inactive coverage, wrong payer or coordination of benefits issues.

Authorization and referral

Missing or mismatched prior authorizations and referrals.

Coding and medical necessity

Code pairing, modifier, bundling and documentation-related denials.

Credentialing and enrollment

Provider not enrolled, not linked to the group, or effective date issues.

Timely filing

Claims submitted or resubmitted after the payer deadline, with proof of timely filing when available.

Duplicate and other

Duplicate submissions, missing information and payer processing errors.

Physician signing documentation to support a claim appeal

Appeals

Written Appeals Backed by Documentation

When a denial cannot be fixed with a corrected claim, we prepare an appeal or reconsideration request following the payer's process, including the relevant clinical documentation, policy references and a clear explanation.

Appeal deadlines are tracked alongside timely filing limits, and outcomes are recorded so we can see which approaches work with each payer.

  • Payer-specific appeal and reconsideration forms
  • Supporting records requested from your team as needed
  • Deadline tracking and outcome logging
  • Root-cause notes shared in regular reporting

FAQs

Claims and Billing FAQs

Still have questions?

Talk with a licensed insurance professional.

(445) 300-7597 Mon–Fri 8am–8pm ET

Getwell Healthcare Solutions helps healthcare providers manage the revenue cycle, including charge entry, claim submission, payment posting, denial management, and accounts receivable follow-up. We tailor our services to your practice’s specialty and workflow. Our goal is to help you get paid accurately while reducing administrative burden.

We work with a range of healthcare providers, including independent physicians, group practices, and specialty clinics. Each practice has unique billing needs, so we begin by understanding your specialty, payer mix, and current processes. Contact us to discuss whether our services are a good fit.

We review denied claims to identify the cause, correct errors, and resubmit or appeal when appropriate. We also look for patterns in denials so that recurring issues can be addressed at the source. This helps reduce future denials and improve cash flow.

Yes. We provide regular reporting so you can see claim status, collections, and outstanding balances. Transparency is central to how we work, and we are available to walk you through reports and answer questions.

In many cases, yes. We can often work within your current practice management or EHR system. During your consultation, we will review your technology setup and discuss the best approach.

We follow HIPAA requirements and use secure processes to handle protected health information. Access is limited to the team members who need it to perform their work. We are happy to discuss our privacy and security practices and sign a Business Associate Agreement.

Denial Backlog?

Let Us Review Your Open Claims and Denials

We can start with a look at your aging and denial reports to identify where recoverable revenue may be sitting.

Request a Consultation Call (445) 300-7597

Consultation

Request a Claims Review Consultation

Tell us about your claim volume, payer mix and the issues you are seeing. Please do not include patient information.

  • Discussion of current claim and denial trends
  • Recommended next steps
  • No obligation

Tell Us About Your Claims

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