A claim that never reaches the payer never gets paid. Claim submission is the final checkpoint before adjudication — where every field is scrubbed, formatted to the payer's exact specification, and transmitted electronically, so it lands as a clean, first-pass acceptance instead of a rejection.
What is Claim Submission?
Claim submission is the process of transmitting a fully coded, charge-entered claim to the payer for adjudication — most commonly as an electronic EDI 837 transaction through a clearinghouse, or, when required, as a paper CMS-1500 or UB-04 form. Before transmission, every claim is run through a final scrub: checking that patient, provider, and payer data are complete, correctly formatted, and consistent with what was verified during eligibility and charge entry.
It's worth distinguishing a rejection from a denial: a rejection means the claim never entered the payer's adjudication system at all — usually a formatting or data error — while a denial means the payer reviewed the claim and declined to pay it. Clean submission is what keeps claims out of the rejection pile entirely.
What poor claim submission costs your practice
A claim held up in submission is revenue held up with it — and payer timely filing windows don't wait.
Missed timely filing deadlines and forfeited claims
Clearinghouse rejections from formatting errors
Eligibility mismatches caught too late to fix quickly
Delayed cash flow while claims sit unsubmitted
Manual resubmission workload piling up on staff
Missed payer-specific submission rules and edits
Every claim leaving Adrotack is scrubbed against payer-specific edits before transmission — and every rejection is triaged and corrected the same day it's flagged, not left to age in a queue.
How every claim gets to the payer clean
Final claim scrub
Patient, provider, coding, and charge data are checked for completeness and consistency across the full claim.
Format validation
Claims are validated against the correct EDI 837P or 837I format, or CMS-1500 / UB-04 for paper submissions.
Clearinghouse transmission
Clean claims are transmitted electronically through our clearinghouse partners for fastest possible delivery.
Acknowledgment tracking
We track 999 and 277CA acknowledgments to confirm each claim was actually accepted into the payer's system.
Rejection triage
Any rejected claim is corrected and resubmitted the same day — before it risks a timely filing deadline.
Confirmation & archiving
Accepted claims are logged and archived with full audit trail, ready for payment posting and reconciliation.
Claim submission services we provide
EDI 837P / 837I claim transmission through trusted clearinghouses
CMS-1500 & UB-04 submission for payers that require it
Clearinghouse management and acknowledgment tracking
Same-day rejection resolution and resubmission
Timely filing deadline tracking by payer
