Medicare claims are processed by one of 12 regional Medicare Administrative Contractors. Each one publishes its own local coverage determinations, which decide what is covered and what the documentation has to show.
Every state runs its own Medicaid program, with its own fee schedule, enrollment, timely filing limit and prior authorization rules. In most states, members are also split across managed care plans that each set their own.
Blue Cross Blue Shield plans are run by separate companies that each cover a state or a region, and the regional plans and networks differ in every market. Each one has its own portal, policies and appeal process.
States set their own prompt-pay deadlines for commercial claims, their own workers' compensation fee schedules and, in some states, no-fault auto rules. Those deadlines decide when a late claim can be escalated.
We look at your current clean-claim rate, denial rate, aging A/R and top denying payers, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, agree who does what and how escalations work, and set up the reporting you want. Most practices are live within one to two weeks.
Charges are entered daily and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, denials worked to their cause, and unpaid claims chased on a schedule, all inside your system.
A report you can read in ten minutes: what was billed, what was collected, what was denied and why, what is aging, and what we changed upstream as a result.
2%
Average claim rejection rate
24 hrs
Claims submitted within
28
Average days in A/R
I’ve been in billing for 30+ years and Summit is the best I’ve worked with. They’re knowledgeable, detailed, and persistent to get claims paid instead of writing them off. They take the burden off providers so we can focus on patients.
We billed in-house for decades, but it was time for a change. I couldn’t be happier with Summit. The transition was seamless thanks to their strong systems and clear communication. If you’re considering a switch, talk to Summit.
50A Northwestern Drive, Salem, NH 03079
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
Mon - Fri @ 9am - 5pm
Summit Billing Solutions has been one of the best decisions for my business. They’re responsive, transparent, and make billing feel organized and manageable. They truly feel like a partner, not a vendor. Highly recommend.