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medical claim

Operations & management

Claim.MD clearinghouse review: What it is and how it works

Claim.MD is a US medical claims clearinghouse. What it does, how it works, prici...

Last Updated: Aug 27, 2026

Circular diagram of the seven revenue cycle management steps, from scheduling and registration through eligibility, coding, claim submission, payment posting, denial management and patient collections.

Operations & management

What is revenue cycle management (RCM)?

Revenue cycle management is every step between booking a patient and banking the...

Last Updated: Aug 27, 2026

laptop with stethoscope

Operations & management

The prior authorization process: A step-by-step workflow for practices

The prior authorization process in five steps, plus the CMS turnaround ceilings,...

Last Updated: Aug 27, 2026

Diagram of three timely filing clocks: initial claim from date of service, corrected claim, and appeal from the remittance date

Operations & management

Timely filing limits by payer: Initial claims, corrected claims and appeals

Timely filing limits for Medicare, Medicaid, BCBS, UHC, Cigna, Aetna and TRICARE...

Last Updated: Aug 27, 2026

Compliance and security

Medical billing compliance: The laws and violations (+ Downloadable checklist)

Medical billing compliance means billing within the law: FCA, HIPAA, AKS. The ru...

Last Updated: Aug 27, 2026

Flow diagram showing an 837 claim followed by a 999 acknowledgment, a 277CA claim acknowledgment and an 835 remittance, with two rejection off-ramps marked

Operations & management

What is an 837 file?

An 837 file is the electronic claim (X12 EDI) providers send to payers. 837P vs ...

Last Updated: Aug 27, 2026

health insurance

Operations & management

How to get credentialed with insurance companies (step by step)

Download your free insurance credentialing document checklist A one-page checkli...

Last Updated: Aug 27, 2026

Annotated sample electronic remittance advice showing trace number, claim status, CO-45 contractual adjustment, CO-197 denial, plan paid, PR-2 coinsurance and a provider-level recoupment

Operations & management

What is electronic remittance advice (ERA)?

An electronic remittance advice (ERA) is the electronic file a health plan sends...

Last Updated: Aug 27, 2026

Illustration of a patient undergoing a blood pressure check by a healthcare professional, with a digital medical monitor in the background.

Clinical guides

Circulation assessment: Parameters, mnemonics and documentation

Circulation assessment covers heart rate, BP, capillary refill, skin, and pulses...

Last Updated: Aug 26, 2026

Three-column diagram of the scrubber, clearinghouse front-end edits and payer adjudication, with what each checks and how failure returns to the practice

Operations & management

What is a clean claim in medical billing?

A clean claim has no errors, so the payer pays it first time. HFMA puts the targ...

Last Updated: Aug 27, 2026

Five-step denial management cycle: identify, categorize, resolve, appeal, prevent, looping back to identify

Operations & management

Denial management in healthcare: Process, causes, and prevention

Denial management is how practices find, fix, appeal, and prevent denied claims....

Last Updated: Aug 25, 2026

Flow diagram showing a claim travelling from a practice as an 837P file to a clearinghouse, on to the payer, and back as an 835 ERA, with a dashed rejection loop returning to the practice

Operations & management

What is a medical claims clearinghouse?

A medical claims clearinghouse validates and routes your claims to payers. Plans...

Last Updated: Aug 25, 2026

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