Medical billing services
Most clean claims submitted within 24 hours, payments posted line by line, and underpayments flagged before they turn into write-offs.
A claim is only as good as the data on it. One wrong subscriber ID, a missing rendering NPI, or a diagnosis that does not support the CPT code is enough for a payer to reject or deny it, and each rework adds weeks to your cash cycle. Good billing catches those problems before submission and then makes sure the payer pays the contracted amount.
At SFA Solutions, claims are reviewed against applicable billing, coding and payer-specific rules (10,000+ in our workflow) before submission to help identify preventable errors. That review covers NCCI edits, modifier requirements and payer policies, and we have a 24-hour target for submitting clean claims after final review. We post ERA and EFT payments line by line, compare each allowed amount to your fee schedule, and flag underpayments for follow-up. Rejections are typically corrected the same day. Denials go to root-cause tracking to help keep the same error from repeating. Our clean-claim target for clients is 95%+, and you see the numbers in a monthly KPI report.
Who this is for
This service suits solo physicians, nurse practitioners and small groups that want claims handled daily without hiring a full-time biller. It is a good fit for practices with high claim volume and simple visits, such as family medicine, internal medicine and urgent care, and for specialties with modifier-heavy billing like dermatology, podiatry and ophthalmology. If you also need eligibility, coding review and A/R cleanup, the full RCM package covers those as well.
Related services
What our medical billing service covers
Charge entry and claim scrubbing
Demographics, insurance, codes, modifiers, place of service and units checked against payer rules before the 837 file goes out.
Daily electronic submission
Most clean claims submitted within 24 hours through your clearinghouse, with clearinghouse and payer rejections typically fixed the same day.
ERA and EFT posting
835 remittances posted at the line level with adjustment and remark codes recorded, so the patient balance and the A/R are both accurate.
Underpayment detection
Allowed amounts compared against your contracted rates. Short payments are appealed and patterns are documented for contract audits.
Denial tracking with root cause
Each denial tagged by CARC and RARC code, payer and cause, then fixed at the source: front desk, coding or provider documentation.
Monthly KPI reporting
Collections, days in A/R, first-pass rate, denial rate and net collection rate by provider, payer and location.
How we deliver it
Day 1
You grant access to your PM system and clearinghouse. We review your payer mix, fee schedules and open claims, and can typically begin within 24 hours of receiving system access.
Week 1
We set up scrubber rules for your top payers and specialty, and correct any rejected or unbilled claims sitting in the queue.
Ongoing
Daily charge review and submission, daily payment posting, and weekly follow-up on anything not paid within the payer's normal window.
Monthly
KPI report and review call covering what was billed, what was paid, what was denied and what we changed to prevent it.
Typical timely filing limits by payer type
| Payer type | Typical filing limit | Note |
|---|---|---|
| Medicare Part B | 12 months from the date of service | Late claims are denied (CO-29) except for narrow exceptions |
| Medicaid | Set by each state, often 90 days to 12 months | Managed Medicaid plans may set their own, shorter limits |
| Commercial plans | Commonly 90 to 180 days | Set by your participation contract; check each payer |
| Medicare Advantage | Per contract if in-network | Plans generally apply Medicare's 12-month limit to non-contracted providers |
| TRICARE | 1 year from the date of service | Inpatient claims are counted from the discharge date |
| Secondary claims | Often counted from the primary payer's EOB date | Window varies by payer; file promptly after the primary pays |
Medical Billing for your specialty
We bill for 28+ specialties. These are the ones we work with most.
Nurse Practitioner billing
Billing for NP-led and physician-NP practices, from the 85% Medicare rate and incident-to rules to split/shared visits and getting each NP credentialed under the right NPI.
Learn moreInternal Medicine billing
Billing for internists who manage complex, chronic patients, with E/M levels, wellness visits and care management codes captured when the documentation supports them.
Learn moreOphthalmology billing
Eye exam codes, refraction, diagnostic testing, cataract globals and high-cost injectable drugs all follow their own rules. Ophthalmology is one of the specialties we bill most often.
Learn moreQuestions about medical billing
How fast are claims submitted?
We have a 24-hour target for submitting clean claims after final review, once the charge and signed note are available in your system, and most clean claims go out within that window. If documentation is missing, we flag it to the provider the same day instead of holding the claim silently.
What is the difference between a rejection and a denial?
A rejection happens at the clearinghouse or payer front end because the claim data is invalid, such as a bad member ID or missing NPI. The claim never entered adjudication, so it can be corrected and resubmitted. A denial means the payer processed the claim and refused payment, which usually requires a corrected claim or an appeal.
Do you check whether payers paid the right amount?
Yes. We load your contracted fee schedules and compare the allowed amount on each ERA line. Short payments are appealed, and repeated variances by a payer are summarized so you can raise them at contract renewal.
Do you send patient statements?
Yes. We send patient statements for deductibles, coinsurance and copays after insurance has paid, and we answer patient billing questions by phone so your front desk is not tied up.
Which billing software do you work in?
We work inside your current system, including Kareo/Tebra, AdvancedMD, eClinicalWorks, athenahealth, Office Ally, DrChrono, CollaborateMD, PracticeSuite, EZClaim, Medisoft and 50+ others. No migration is needed.
Start with a free review
Tell us a little about your practice. We will look at where medical billing is costing you money today and walk you through what we find.
- No commitment
- Reply from an RCM specialist, typically within one business day
- No patient records needed to start
Get a free review
An RCM specialist typically replies within one business day.