Types of Claim Submission in Medical Billing You Must Get Right the First Time
Medical claim submission begins with selecting the appropriate submission method for each claim. When claims are submitted using the correct method, purpose, and format, they are processed more efficiently by insurance payers.
A clear understanding of the different claim submission types helps reduce rework, supports first-pass claim acceptance, and maintains consistency throughout the billing process. This blog explains the types of claim submission in medical billing and highlights why selecting the correct submission type at the first attempt supports smoother claim processing and reduced follow-up activity.
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What Are Types of Claim Submission in Medical Billing
Types of Claim Submission in Medical Billing describe the standardized methods used to transmit healthcare claims to insurance companies. Within the medical billing claim submission workflow, the selected submission type defines how the payer reviews and processes the claim. Because insurance payer processing systems follow predefined rules, correct classification is required at submission. The following are the types of claim submission used in medical billing.
Primary Types of Claim Submission Based on Submission Method
Claim submission methods determine how healthcare claims are delivered to insurance payers. The selected method affects claim transmission, payer review, and processing timelines. Choosing the correct method supports proper routing and timely handling.
Electronic Claim Submission
Electronic claim submission allows providers to send claims digitally through billing systems or intermediaries. According to industry data, over 90% of U.S. healthcare claims are submitted electronically. Electronic claim submission in medical billing supports faster acknowledgment and payer responses compared to manual methods, making it the standard for most practices.
Paper Claim Submission
Paper claim submission involves mailing physical claim forms to insurers. Paper claim submission in medical billing is still required by some payers for specific services or corrections. However, paper insurance claims often take two to three times longer to process due to manual data entry and mailing time.
Direct Claim Submission
Direct claim submission occurs when providers submit claims through payer-specific online portals. This method bypasses third parties and requires close attention to payer claim submission requirements, as portal rules vary by insurer and service type.
Clearinghouse Claim Submission
Clearinghouse claim submission uses a third-party platform to review claims before they reach insurers. Clearinghouses apply formatting and payer-specific edits, helping catch errors early in the insurance billing claim process and reducing front-end rejections. For more insights on why a clearinghouse is a strategic partner in claims submission, clearinghouses also support better claim routing and payer compliance.
Types of Claim Submission Based on Claim Volume
Claim volume influences how submissions are grouped and transmitted to payers. Depending on the number of claims generated, providers may submit claims individually or in groups. Selecting the appropriate volume-based approach helps manage workload and submission consistency.
Batch Claim Submission
Batch claim submission refers to sending multiple claims together in a single transmission. This approach is common in hospitals and large practices that submit hundreds or thousands of claims daily. Batch processing improves workflow efficiency but requires thorough internal review to avoid repeating errors across many claims.
Individual Claim Submission
Individual claim submission involves sending one claim at a time. This method is often used for unusual services, high-cost procedures, or claims that require manual verification before submission.
Overview of Claim Submission Methods in Medical Billing:
Types of Claim Submission Based on Claim Purpose
Claim purpose determines why a claim is being submitted and how the payer evaluates it. Whether a claim is new, revised, or sent again after a payer response, the submission purpose guides processing logic. Correctly identifying the claim purpose helps payers apply the appropriate review path.
Original Claim Submission
Original claim submission is the first time a claim is sent to a payer for reimbursement. This submission sets the foundation for medical billing claims processing and must include complete provider, patient, and service details. For a clearer understanding of how claims are expected to be submitted at this stage, this claim submission method guidance provides helpful context on accepted submission approaches.
Corrected Claim Submission
Corrected claim submission is used when an original claim needs changes after submission. This may involve updates to diagnosis codes, procedure codes, or patient information. Corrected claim submission must reference the original claim number so payers recognize it as a replacement.
Claim Resubmission
Claim resubmission occurs when a payer returns a claim unpaid and requests follow-up. Resubmitted insurance claims are sent again after reviewing payer feedback, often as part of claim follow-up and resubmission activities within the billing cycle. Proper coding review is often part of this process, as noted in effective coding and claim resubmission practices, which supports consistent claim outcomes.
Classification of Claims by Submission Purpose:
Types of Claim Submission Based on Claim Format
Claim format determines how service and provider information is structured for payer review. Different formats are used based on whether services are billed by individual providers or healthcare facilities. Selecting the correct format allows payer systems to interpret claim details correctly.
Professional Claim Submission
Professional claim submission applies to physician and outpatient services. These claims are typically sent using CMS-1500 claim submission standards, which include provider identifiers, procedure codes, and service dates.
Institutional Claim Submission
Institutional claim submission is used by hospitals and facilities for inpatient and outpatient services. UB-04 claim submission formats support multiple service lines and revenue codes under one claim.
Why Getting Claim Submission Right the First Time Matters
Getting claim submission right the first time is important because insurance payers rely on automated systems to evaluate incoming claims. When claims are submitted correctly at the initial stage, they move through payer review without interruption. High first-pass claim acceptance reduces rework, limits follow-up activity, and shortens reimbursement timelines. In contrast, incorrect submissions lead to repeated reviews, increased administrative effort, and delayed payer responses.
If you are interested to read more about Claims, please have a look at this blog on ‘‘Physical Therapy Claim Denials: Common Denials and Solutions’’
Common Mistakes That Occur When Using the Wrong Claim Submission Type
Using an incorrect claim submission type causes payer systems to process claims incorrectly. These mistakes usually happen when the submission purpose, method, or format does not match payer requirements, leading to returned or unpaid claims. Below are some of the most common mistakes seen when claim submission types are not selected correctly.
Submitting a Corrected Claim Without Linking the Original Claim
When users submit a corrected claim without referencing the original claim number or frequency code, payers treat it as a duplicate. This results in rejection and requires another submission, adding avoidable delays.
Resubmitting Claims When Corrections Are Required
Many users resend denied claims instead of selecting the corrected claim option. This causes the same incorrect data to be processed again, leading to repeated denials and additional follow-up work. These repeated delays can also push claims closer to filing deadlines, which makes guidance on timely filing denial prevention especially relevant when corrections are required.
Choosing the Wrong Claim Format for the Service
Submitting facility services on professional claim formats, or physician services on institutional formats, prevents payer systems from reading claim data correctly. Users often face claim returns before any review begins.
Using Batch Submission for Claims That Require Individual Review
Some claims, such as high-dollar services or adjusted claims, require individual submission. When users include these in batch files, payers may suspend or reject the entire batch.
Submitting Claims Through an Unsupported Channel
Sending claims through clearinghouses when a payer requires portal submission, or using paper when electronic filing is mandatory, leads to stalled or rejected claims and missed filing timelines.
How to Choose the Right Types of Claim Submission in Medical Billing
Choosing the right Types of Claim Submission in Medical Billing begins with understanding payer rules, claim intent, and prior submission history. Each claim must be submitted using the method, purpose, and format expected by the payer to avoid delays or returns. Reviewing these factors before submission supports smoother insurance claim submission process outcomes.
Key steps to determine the correct claim submission type include:
Reviewing payer-specific submission guidelines and accepted formats
Confirming whether the claim is original, corrected, or a follow-up
Selecting the appropriate submission method based on payer instructions
Verifying the correct claim format for the service provided
Checking timely filing limits before submitting or resubmitting claims
Following these steps helps reduce avoidable payment delays and supports consistent claim processing.
Conclusion
Selecting the correct claim submission type at the first attempt influences how claims are reviewed and processed by insurance payers. When the submission method, purpose, and format align with payer requirements, claims move forward with fewer interruptions and reduced follow-up activity. Applying the right submission approach from the beginning supports more predictable outcomes across the billing cycle.
If managing multiple submission requirements has become challenging, experienced claim submission services can support accurate and timely filing across payers. To learn how streamlined submission support can fit your billing operations, contact MBW RCM to discuss your requirements.
FAQs: Types of Claim Submission in Medical Billing
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Selecting the wrong claim submission type can lead to returned claims, delayed responses, and added follow-up work. Complete the form below to receive guidance on choosing the correct claim submission method, purpose, and format, aligning submissions with payer requirements, and improving first-pass claim acceptance across the billing workflow.
