1 min read

[News!] primeclaims, company of the year 2022!

By Prime Care Tech Marketing on Tue, Feb 07, 2023 @ 04:12 PM


PrimeCLAIMS Clearinghouse Propels Proclaim Partners to "Company of the Year"

The Financial Services Review has awarded ProClaim Partners “Company of the Year in its Claims Processing Solutions Providers category for 2022,” for outstanding innovation with its primeCLAIMS clearinghouse.  We are honored to be acknowledged for the technology and performance we bring to Post Acute Care and other industry claims processing.

When healthcare billers transitioned out of COVID, they had to do more with less. In 2022, primeCLAIMS streamlined the claims process, creating a higher standard of superior performance through technology.

Jonathan Duvall, Senior Director of Product Management, says, “Our goal is to provide software that goes beyond processing claims and integrates into an organization’s revenue cycle workflow. By studying workflow, primeCLAIMS delivers an intuitive experience to get companies paid every dollar for every day of patient care.”

- primeCLAIMS Clearinghouse facilitates seamless electronic claim submissions by automating the claims handling process.

- primeCLAIMS Sequential Billings compares month-to-month billing through side-by-side, claim-to-claim comparisons to detect discrepancies.

- primeCLAIMS Enhanced Aging lets you compare what was billed VS what was paid and highlights discrepancies of missing payments.

- primeCLAIMS EzDDE enables billers to edit hundreds of lines quickly and move to the next claim - saving up to 30 minutes per claim.

PrimeCLAIMS continues to work towards innovations and deliver technologies that focus on billers. Don't hesitate to contact Jae Sparks VP of Sales & Marketing, at 770-543-0473, to schedule a demo.

Topics: claims submissions secondary claims managing claims LTC Claims primeCLAIMS
1 min read

[Webinar On-Demand] Best Practices in LTPAC Revenue Cycle Management

By Prime Care Tech Marketing on Thu, May 18, 2017 @ 02:18 PM

If you missed it or want to review it again, our Best Practices in LTPAC Revenue Cycle Management Webinar replay and slides are now available. This webinar offers top tips from our 25+ year veteran, Kimberly Sturm, and our seven years of helping post-acute care clients get claims paid faster and with less hassle.

If it's time to streamline your claims processes, be sure to schedule a demo with us for help. Our clients report that our primeCLAIMS  solution cuts processing time by up to 50%, helping them recover revenue faster.

Topics: revenue cycle management MSP Medicare Secondary Payer secondary claims claims processing automation post-acute claims clearinghouse
2 min read

Spotlight on April’s Revenue Cycle Management Blogs

By Prime Care Tech Marketing on Thu, Apr 28, 2016 @ 02:00 PM

Revenue-Cycle-Management-Blog-Spotlight-322x221.jpgRevenue Cycle Management is constant, a year-round effort, but periodically worth occasional scrutiny and cleaning up. Likewise, if you bill Medicare for services and need to file secondary claims, then taking a look again at automation through a clearinghouse may result in cleaning up those outstanding AR balances. This month’s blogs offer useful insights to help AR managers refresh revenue cycle best practices and remove the clutter of uncollected revenue.  

Spring clean your revenue cycle

This is the time of year to open the windows, air out the house, deep clean long neglected spaces, and tidy up. For AR managers, it’s also a good time to “spring clean” the revenue cycle in a few key ways.

  1. Update and refresh your payers’ contracts “wiki”.
  2. Check the aging.
  3. Revisit your pre-admission screening procedures.
  4. Make sure the census is correct.
  5. Stay on top of your Days Sales Outstanding (DSO).
  6. Conduct a thorough claims triple check.
  7. Engage the right clearinghouse.

Learn how these steps can help you freshen up your revenue cycle management practices.


Secondary payer claims – finding ROI (Reducing Outstanding Income)

The ROI of automating secondary claims through a claims clearinghouse is potentially huge. Traditionally billers completed paper forms and mailed them to the payer. Sounds simple, but it wasn’t and, some providers are still submitting claims in this way. Phone calls and error-generated resubmittals contribute to a complex, cumbersome, costly, and prolonged payment process. With electronic claims automation, providers can securely submit and track claims to multiple payers all in one portal. In this blog, we highlight some of the advantages a claims clearinghouse can offer and the potential ROI when doing so.

Discover the benefits and ROI of automating secondary claims submission. 


Are you collecting all your secondary claims and
how much does it cost to do so?


Check it out!


Topics: automated revenue cycle management system revenue cycle management Medicare Secondary Payer secondary claims revenue cycle secondary payer
2 min read

Secondary payer claims – finding ROI (Reducing Outstanding Income)

By Prime Care Tech Marketing on Fri, Apr 08, 2016 @ 03:27 PM

iStock_000062942648_Small.jpgIn a recent blog, we highlighted some benefits of automating secondary claims processing through a clearinghouse. The ROI is potentially huge.

Traditionally billers completed paper forms and mailed them to the payer. Sounds simple, but it wasn’t and, some providers are still submitting claims in this way. Phone calls and error-generated resubmittals contribute to a complex, cumbersome, costly, and prolonged payment process. With electronic claims preparation and submittal, providers can securely submit and track claims to multiple payers all in one portal. Here are some of the advantages a claims clearinghouse can offer:

  • Single location electronic claims management with real-time electronic claims verifications
  • Smooth claims flow to payers with a significantly reduced risk of rejections - since claims clearinghouses are connected to multiple payers and understand the peculiar format and workflow requirements
  • Electronic Remittance Advice (ERA) –view all payments and adjustments
  • Claim Status Reports
  • Rejection analysis in which the system explains error codes in English
  • Edit and correct claims online anytime
  • Real-time support

ROI - Secondary claims process saves time

Think of time savings in two ways:

  1. Billers’ time – The manual workflow of copying, mailing, and filing claims takes time. Even hand keying claims to each payer takes time. Billers have to know the specific submission requirements of each payer. In a manually-generated claims environment, such complexities can result in errors and slower claims turnaround. With a clearinghouse, such as primeCLAIMS, the system prepares the secondary claims automatically. All billers have to do is review the claims in the Secondary tab and click on the button to send them. It’s simple. And our customers love using it. The ROI? A reduction in claims processing and related costs.
  1. Claims turnaround time - Office Managers can go right to the Secondary payer tab once they have downloaded the 835 ERAs (Electronic Remittance Advices). The secondary claims are there for review and submission. No delays. And the claims are accurate and prepared automatically to meet payer-specific requirements the first time. The ROI? A reduction of 4-6 weeks in claims turnaround and payment. One of our customers has stated that it has had a major impact on the reduction of Days Sales Outstanding (DSO).

To give you an idea of what’s at risk, if you are not using a clearinghouse to submit secondary payer claims, take a look at our Secondary Claims ROI calculator and see for yourself. The calculator helps you to identify what revenue may be at risk as well as the time and money it takes to manually generate the claims.

Are you collecting all your secondary claims and how much does it cost to do so?

Check it out.

Topics: clearinghouse ROI electronic claims secondary claims secondary payer
2 min read

Ensure Managed Care claims flow smoothly

By Prime Care Tech Marketing on Sat, Mar 19, 2016 @ 07:00 AM

iStock_000026202961_Small.jpgPartnering with a clearinghouse with connections to many payers makes submitting claims easier and keeps cash flowing consistently. Keeping cash flow in a steady stream means understanding how managed care works – knowing the systems, procedures, and requirements are critical. A clearinghouse, like primeCLAIMS, has connections with multiple MCOs and has built into its system the pertinent requirements, procedures, and systems no matter the size of the MCO. It’s worry-free - especially when working with a clearinghouse well established in and familiar with LTC and managed care. The clearinghouse will have the people who can effectively help you, because they have done it themselves.

Getting on board with an MCO – the application process

A real clearinghouse partner, like primeCLAIMS, will send you the correct form with instructions regarding how to fill it out. It can help you confidently connect the dots and fill in the right blanks with the right information. Before submission to the MCO, you can send a copy to the clearinghouse so that its experts can review it for completion and correctness and help with follow-up. The clearinghouse can also anticipate when you should receive the response and will be there for you until you receive the final approval. It plays an active advisory role throughout the application process and it’s that personal touch that truly identifies a clearinghouse as a real partner.

Medicaid Managed Care can be a different animal

Once you have the contract, knowing how and when to submit claims can be stressful for operators, especially since many states with Medicaid Managed Care, like Tennessee, Arizona, and California, among others, have multiple contracted Managed Care Organizations (MCOs) to run the program. It’s complicated. However, you can let the clearinghouse ease some of the pain for you. It knows what information is required, where to send the claims, and how to deal with the MCOs, even the very large ones.

Example: Some MCOs have a 90-day filing limit policy. In contrast to the traditional 12-month initial claims submissions window for fee-for-service Medicare and Medicaid models, if MCOs do not receive the claims within 90 days, they won’t pay. The clearinghouse will help you submit claims within the filing time period.

Another example: Medicaid recipients can either select an MCO or the state selects one for them. A further wrinkle in the process is when the Medicaid recipient moves from one MCO to another and you may not know about it. The result? Billers will be submitting claims to multiple MCOs in any given month. The clearinghouse will help you stay on top of these this.

Note: Creating secondary payer claims should be a primary concern

When Medicare Managed Care is the primary payer, you may still need to submit claims to another payer to pick up the co-insurance. The clearinghouse should create the secondary claims automatically.

Note: Rejecting claims, not a batch of claims

If there are errors in the claims, primeCLAIMS isolates individual claims not the entire batch. While you are fixing the rejected claims, primeCLAIMS submits the rest of the batch for payment. This avoid unnecessary payment delays.


Having the right clearinghouse partner can help your inbound cash flow freely no matter how complicated the MCO payment process can be.

It makes cents.

Claims Process

Topics: clearinghouse MCOs Managed Care Organizations secondary claims MCO application Medicaid Managed Care primeCLAIMS fee-for-serv


Posts by Tag

See all