Most denials are decided before anyone clicks submit. The member ID came off a blurry card photo, the patient changed plans in January and nobody re-verified, or the authorization covers a different code than the one performed. Clean claim submission is won or lost at the front desk and the coding handoff, well before the scrubber sees anything.
What the free claim audit looks like
Page one sets who completes it and the decision it supports. The result page names the stage to fix first.
A clean claim is one the payer accepts the first time
That means accepted and adjudicated on first submission with no rework. Clearinghouse acceptance only says the format was valid, so a practice measuring there can look clean while the payer denies. A claim rejected up front never reaches the payer at all, and it never shows up in A/R.
One calendar year
The Medicare limit for filing a claim from the date of service, under 42 CFR 424.44. Commercial windows are often much shorter, and a claim sitting in a rejection queue keeps running out that clock.
Working denials after the fact costs staff time twice, and the fix sits upstream at scheduling, the front desk, and the coding handoff. For the full path a claim travels, see the 10 steps of medical billing.
What is inside the free claim audit
- 31 controls across the eight stages, from booking the appointment to working the remittance, each marked BLOCKER or RISK
- The front-desk checks that stop eligibility and coordination of benefits denials, including re-verifying established patients
- A stage summary that counts gaps stage by stage, so the one leaking the most denials stands out
- A result that names the stage to fix first, your top three gaps, a 30-day fix plan, and three numbers to track every month
It is a 6-page fillable PDF. Plan on about 45 minutes, and it goes fastest with the front desk and billing in the same room.
How HRG gets claims out clean
HRG's U.S.-based billers scrub every claim before submission, get it out within 48 hours of service, and work any denial within 24 to 48 hours of receipt. The work happens inside a set of supported EHR and practice management systems, with no separate dashboard to log into. Read more about HRG's medical billing services.
98 percent
The first-pass claim acceptance rate HRG targets on the accounts it manages, a track record confirmed by its CFO.
Before you download
Who is the claim audit for?
Billing managers, front-desk leads, and whoever owns the scrubber rules. It works best when the people at each stage answer for their own controls.
How long does it take?
About 45 minutes for the audit itself. After that, the three monthly numbers show whether the fix held.
Does HRG handle coding or prior authorizations?
Coding stays with your coders or coding vendor, with coding consultation from HRG as needed. Prior authorization stays with the practice, and HRG can advise on the workflow, including catching requirements at scheduling.
Can HRG work inside our current EHR and clearinghouse?
HRG works inside a set of supported systems. A quick call confirms whether yours is one of them.
Get the free Clean Claim Control Audit
"HRG's support has been invaluable in establishing efficient systems, maintaining compliance, and providing peace of mind that our operations are secure and well-managed."Tara Roney, HRG client
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