50–60% of Denied Claims Are Never Resubmitted
Revenue loss often begins with denied, rejected, or underpaid claims that are not followed up effectively. At Svizzera Healthcare Solutions, we provide comprehensive Claims Management and Denial Prevention services that ensure every claim is accurately prepared, submitted, monitored, and resolved.
95%+ clean claim rate · MGMA benchmark
Every denial worked · Zero abandoned
Timely filing deadlines tracked per payer
HIPAA-focused · BAA provided at onboarding
Our Claims Management
Services
Every claim submitted clean. Every denial worked. Every payment posted. No gaps, no abandoned claims, no unexplained write-offs.
Clean Claim Submission
Our team reviews every claim before submission to verify diagnosis and procedure codes, modifiers, provider information, payer-specific requirements, and supporting documentation.
Denial Management & Appeals
Denied claims are carefully analyzed to identify the root cause. We prepare corrected claims or appeal packages with the necessary supporting documentation and submit them within payer deadlines.
Claim Status Monitoring & Follow-Up
After submission, we continuously monitor claim status through clearinghouses and payer portals, promptly addressing pending claims and processing delays.
Payer Correspondence Management
We manage communication with insurance payers, respond to documentation requests, resolve claim inquiries, and ensure all payer requirements are met within required timeframes.
Rejection vs. Denial Triage
Claims rejected before adjudication due to missing or incorrect information are corrected and resubmitted quickly to prevent payment delays and reduce administrative burden.
Underpayment Detection & Recovery
Payments are reviewed against payer contracts and expected reimbursement amounts. Any discrepancies or underpayments are identified and followed up to collect full earnings.
Your Claims Lifecycle
Managed End-to-End
From pre-bill validation and clearinghouse tracking to denial appeals and underpayment audits.
Claim Review & Validation
Every claim is thoroughly reviewed to identify coding errors, missing information, payer edits, and documentation gaps before submission.
Electronic Claim Submission
Validated claims are submitted electronically through clearinghouses with submission confirmation and acceptance tracking.
Claims Monitoring
Our specialists monitor claims throughout the adjudication process, proactively addressing delays and payer requests.
Denial Triage & Appeal Filing
Denied or rejected claims are investigated, corrected when appropriate, and appealed with complete supporting documentation.
Payment Posting & Performance Analysis
Payments are posted accurately, underpayments are investigated, and performance reports are generated to improve future claim outcomes.
clean claim rate — the MGMA benchmark that Svizzera targets for every practice engagement, compared to below-85% without a dedicated partner.
Source: MGMA industry clean claim rate benchmark. Actual performance varies by practice type and payer mix.
Six Ways Our Claims Management
Protects Your Revenue
Pre-submission scrubbing. Every denial worked. Timely filing protected. Monthly performance transparency.
Pre-Submission Claim Scrubbing
NCCI bundling edits, MUEs, diagnosis-procedure compatibility, and payer-specific rules are caught before claims leave your system.
MGMA Benchmark Standard
Every claim is managed to the MGMA-defined 95% clean claim rate benchmark with month-over-month tracking and upstream error prevention.
Every Denial Worked
No denial is written off without a documented resolution — whether an accepted appeal, a corrected resubmission, or secondary billing.
Timely Filing Protection
Payer-specific timely filing deadlines tracked per claim from 90-day commercial windows to 12-month Medicare limits.
HIPAA-Focused · BAA at Onboarding
BAA executed before accessing PHI. Encrypted data environments, role-based access controls, and full audit trail maintenance from day one.
Claims Performance Dashboard
Monthly reports detailing clean claim rates, first-pass acceptance, denial trends by payer, and appeal success rates.
MAJOR PAYERS WE SUBMIT TO
Frequently Asked Questions
Answers to the most common questions healthcare organizations ask before partnering with Svizzera.