Medical coding turns patient diagnoses and treatments into standard codes, such as CPT, ICD-10-CM, and HCPCS, that insurance companies use to process claims.
Medical billing uses those codes and patient information to prepare insurance claims, submit them to payers, follow up on unpaid claims, and record payments.
Revenue cycle management (RCM) covers the entire payment process, from patient registration and insurance verification to collecting payments and resolving outstanding balances.
We handle seven key parts of the billing process, from checking insurance coverage to tracking payments and unpaid claims.
Before a patient receives care, we check their insurance coverage and benefits. This helps your team identify coverage issues early and avoid unnecessary billing delays.
This is one of the first steps, before charges are prepared and claims are submitted.
Checking coverage early prevents avoidable claim issues and reduces the time your staff spends correcting insurance details later.
We turn the services your practice provides into billable charges and help make sure the right medical codes are used. We also check for missing details before claims are prepared.
After the patient visit, we prepare the charges and coding information needed to create a claim.
Accurate charges and codes help reduce billing errors, unnecessary corrections, and delays in claim processing.
We review each claim for missing details and possible errors before sending it to the insurance company. Once submitted, we track its status and address any rejections.
Once charges and codes are ready, we prepare and submit the claim to the appropriate payer.
Reviewing claims before submission helps catch mistakes early, reduces unnecessary rework, and keeps claims moving toward payment.
When an insurance company denies a claim, we look into the reason and work on the next steps. Our team handles corrections, follow-ups, and appeals when needed.
This step begins when an insurance company denies a claim or requests corrections after submission.
Unresolved denials can delay payments and create more work for your staff. Regular follow-up helps your practice address these claims before they remain unpaid for too long.
Some claims remain unpaid even after they are accepted by insurance companies. We track these outstanding claims and follow up with payers to find out what's holding up payment.
After claims are submitted, we continue checking unpaid balances until they are resolved or the next action is identified.
Regular follow-ups help prevent unpaid claims from being overlooked and give your practice a clearer picture of outstanding revenue.
When insurance companies send payments, we record the amounts and update patient accounts. We also review payment details to identify differences that may need further attention.
This step takes place as payments and remittance details arrive from insurance companies.
Accurate payment posting keeps account balances up to date and helps your team see what has been paid and what is still outstanding.
We keep your practice informed about its billing activity. Our reports help you understand which claims have been paid, which are still pending, and where problems need attention.
Reporting connects every stage of the billing process and helps your practice review ongoing performance.
Clear reports help you understand where your money stands, spot billing problems, and make better decisions about your revenue cycle.
Here's how we work with your team, manage claims, and keep you updated throughout the process.
We start by checking patient and insurance details before claims are prepared. If we find missing information or coverage issues, we let your team know so they can be corrected early.
Shares patient details, insurance information, and appointment records.
Checks insurance eligibility and identifies missing or incorrect details.
Verified patient and insurance information for claim preparation.
After the patient visit, we review the charges, diagnosis codes, and procedure details. We check for missing information and work with your team to correct any issues before preparing the claim.
Provides visit notes, services performed and required documentation.
Reviews charges, checks coding details, and prepares claims.
A completed claim ready for submission.
We send prepared claims to the insurance company and track their status. If a claim is rejected, we review the reason, make the necessary corrections, and resubmit it.
Provides any additional information requested.
Submits claims, tracks responses, and corrects rejected submissions.
Claim status and any issues needing further action.
When a claim is denied or remains unpaid, we contact the insurance company to find out why. We handle corrections, follow-ups, and appeals when needed to help resolve outstanding claims.
Shares additional records or information when needed.
Reviews denials, follows up with payers, and handles claim corrections.
Updated claim status and any remaining actions.
When payments arrive, we record them and check for outstanding balances. We also review billing activity and share reports so your practice can see what's been paid and what still needs attention.
Reviews billing reports and helps resolve questions when needed.
Posts payments, checks balances, and prepares billing reports.
Updated accounts and a clear view of billing performance.
You can keep using your current EHR and practice management software. MedexCore works with your team, handles the billing tasks you need help with, and keeps you updated.
You don't have to switch software to work with us. We review your current EHR and practice management system, arrange the access needed for billing, and fit our work into your existing process.
To keep your billing work moving, we'll need:
Your practice needs more than someone to submit claims. We help you manage billing tasks, follow up on unpaid claims, and keep track of your revenue.
Here's what makes our approach different.
Every practice has different billing needs. We look at your specialty, practice size, and insurance requirements to provide support that fits your workflow.
You get billing support that works with your existing process instead of having to change how your practice operates.
Our work doesn't stop after submitting a claim. We track unpaid claims, review denials, and follow up with insurance companies to help resolve payment issues.
Regular follow-ups help prevent claims from being overlooked and keep your team informed about outstanding payments.
We make sure your team knows who handles each billing task and who to contact when questions come up. We also keep you updated on issues that need your attention.
You don't have to contact different people to find out what's happening with your claims. You know who to reach and what needs to happen next.
We provide clear reports on claims, payments, denials, and outstanding balances. We also review recurring billing problems to find areas that need improvement.
You can see how your billing is performing, understand where payments are getting delayed, and make informed decisions.
You can manage billing in-house or work with an outside company. Here's how we compare with these options.
| Feature | MedexCoreOur approach | Other Billing Providers | In-House Billing |
|---|---|---|---|
| Billing Coverage | Connected billing support from claims to payments | Depends on service agreement | Managed by your staff |
| Denial Handling | Reviews, corrections, and payer follow-ups | Depends on service scope | Handled by billing staff |
| Specialty Support | Billing workflows adapted to your specialty | Depends on provider expertise | Depends on staff experience |
| Reporting | Clear updates on claims, payments, and A/R | Varies by provider | Depends on internal reporting |
| Existing Software | Works with your current EHR/PM where compatible | Depends on provider | Uses existing systems |
| Workload Management | Assigned billing responsibilities and team support | Depends on staffing and contract | Depends on staff availability |
A clear view of billing activity, outstanding claims, and issues that need attention.
We noticed more eligibility-related denials from one insurance company. We'll review coverage details more closely before submitting claims to that payer.
Nine claims have been unpaid for 91–120 days. We've marked them for payer follow-up to find out what's delaying payment.
Several claims were denied for similar coding reasons. We'll share these issues with your team and review the details before future submissions.