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Medical Claims Processing Outsourcing

Magellan Solutions handles the claims leg of your revenue cycle — scrubbing claims before they go out, submitting them through your clearinghouse, tracking status with payers, and working rejections and denials back to payment. Our teams work inside your practice management system, clearinghouse and payer portals under HIPAA-conscious workflows, so more claims are accepted on first pass and fewer sit unresolved past the point where they can be fixed.

At a Glance

Best For Medical billing and RCM companies, high-volume outpatient providers (physical therapy, chiropractic, behavioral and mental health), DME suppliers, diagnostic labs and imaging centers, and multi-specialty groups whose in-house billing team needs overflow capacity
Core Support Claim scrubbing, electronic claim submission, claim status tracking, rejection management, denial management and appeals, secondary and coordination-of-benefits claims
Delivery Philippines-based delivery inside your practice management system, clearinghouse and payer portals

A rejected claim costs far more than the claim balance

A claim that comes back is not just a delayed payment — it is the same work done twice, by staff who were already behind. Scrubbing errors send claims back before a payer ever adjudicates them. Claims submitted and then never followed up sit in payer queues while the timely-filing window closes around them. Denials arrive at a team with no capacity to appeal them, and get written off instead of worked.

 

None of that shows up as a line item. It shows up months later as revenue that never arrived, and as an AR report nobody can explain. Put your claims with a team that has supported healthcare providers since 2005.

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Our Medical Claims Processing Capabilities

Claims work is sequential, and a gap at any stage costs the whole claim. We cover the full path from scrub to resolution — as a standalone program, or alongside the rest of your revenue cycle.

Claim Scrubbing & Pre-Submission Review

Every claim checked against payer-specific rules and known rejection triggers before it leaves your system. Catching an error here costs minutes. Catching it after a payer does costs weeks.

Electronic Claim Submission

Submitted through your existing clearinghouse on your schedule, with batch monitoring and confirmation that every claim actually landed — not just that it was sent.

Claim Status Tracking & Payer Follow-Up

Systematic follow-up on claims that have gone quiet, including the payer phone work internal teams rarely have hours for. Claims get chased before they age out.

Rejection Management

Rejections never reached adjudication, so there is nothing to appeal — only data to fix. We work clearinghouse reports daily, correct, resubmit clean, and log every reason so the same edit stops firing.

Denial Management & Appeals

Denials were adjudicated and refused, and the appeal clock is running. Corrected resubmission where that resolves it, formal appeal where it doesn't, repeat patterns reported back to you.

Secondary & Coordination-of-Benefits Claims

Secondaries filed as soon as the primary remittance lands, with COB data kept current. These are the claims most often left unfiled — and simply written off.

Where Claims Processing Fits in Your Revenue Cycle

Claims are one stage of a longer process, and most claim problems are actually born upstream. If denials are your real concern, the fix usually sits earlier in the cycle:

 

  • Medical Coding — accurate ICD-10, CPT and HCPCS coding, so claims are correct before they are ever scrubbed
  • Insurance Benefits Verification — coverage confirmed before the visit, which removes the single most common denial reason
  • Prior Authorization — approvals secured before the date of service
  • Medical Billing — charge entry, payment posting and AR follow-up on the other side of adjudication

 

Each can be outsourced on its own or run together as one integrated program under revenue cycle outsourcing.

 

If you have no billing function in-house at all — a solo or small practice where one person handles everything from charge entry to collections — claims processing on its own won't solve the problem. Medical billing or the full revenue cycle is the better starting point.

Why Healthcare Organizations Outsource Claims Processing

Claims processing is rule-driven, high-volume and measurable — the profile of work that outsources well. It is also the work that gets deprioritized first when a team is short-staffed, which is exactly when it costs the most.

Cost Reduction

Philippine delivery runs 40–60% below onshore, without carrying that cost through slower months.

Higher First-Pass Acceptance

Disciplined scrubbing against payer rules means more claims accepted the first time, and less rework downstream.

Fewer Claims Lost to Timely Filing

Claims that go quiet get followed up on a schedule rather than when someone gets to them, so fewer close out unpaid.

Denials Worked, Not Written Off

A dedicated team has the hours to appeal — and the visibility to spot the payer and code combinations that keep denying.

Overnight Turnaround

Philippine hours run against the US business day. Claims and rejections queued at the end of your day are worked before the next one starts.

Compliance

Claims handled under HIPAA-conscious, regulation-aware process.

Claim Types We Handle

Most practices carry a mixed payer mix, and each type behaves differently. A team that handles commercial claims well and stalls on everything else leaves your hardest claims exactly where they were.

 

Commercial payer claims — contract-specific rules that change on renewal, varying by plan and by payer.

 

Medicare and Medicare Advantage — government-program requirements and timelines that differ from commercial claims at almost every step.

 

Medicaid — rules that vary state to state, and managed-Medicaid plans that add another layer on top.

 

Workers' compensation — a separate documentation and authorization track, with claim forms, employer and carrier correspondence, and adjuster follow-up that look nothing like a standard payer claim.

 

Secondary and coordination-of-benefits claims — the claims most often abandoned, because they require the primary payer's remittance before they can go out and rarely get revisited once the primary pays. We file them on schedule and follow them up like any other claim.

Compliance and Data Security, Built In

Outsourcing revenue cycle work means trusting someone else with protected health information and payment data — and that trust is only worth extending to a partner who can show its safeguards. Magellan Solutions operates under certified security standards, documented confidentiality policies, and business-continuity planning.

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Certified Standards

Magellan holds ISO 27001, PCI-DSS, and HIPAA certifications — the recognized benchmarks for information security, payment data, and protected health information. See our certifications.

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Controlled Data Access

Network and IT infrastructure sits in secured, IT-only locations. Workstations and servers are password-protected across access levels, and physical data-entry points are disabled to prevent unauthorized transfer.

Enforceable Confidentiality

Every employee signs a confidentiality agreement before job assignment — subject to Philippine law and prosecutable on breach. Access to your data is limited to the team working your account.

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Continuity You Can Count On

Continuous data backup with off-site copies, a co-location plan with a backup center outside a 10-mile radius, and power-blackout protection — so patient support doesn't stop when circumstances change.

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    Who We Support

    Independent & Small-Group Practices

    Medical Billing Companies

    Behavioral & Mental Health

    Physical Therapy

    Chiropractic

    DME Suppliers

    Dental

    Home Care

    Our Onboarding Process

    Requirements Setting

    1

    1

    Call center outsourcing

    Recruitment

    2

    2

    Agent Training

    3

    3

    Campaign Incubation

    4

    4

    Campaign Go Live

    5

    5

    Frequently Asked Questions

    FAQ
    What is medical claims processing outsourcing?
    Delegating the claims leg of the revenue cycle — scrubbing, submission, status follow-up, rejections and denials — to a specialized team, so billing staff aren't splitting their time between new claims and rework on old ones.
    What's included, and what isn't?
    Included: claim scrubbing, electronic submission, status tracking and payer follow-up, rejection correction and resubmission, and denial management and appeals. Coding, benefits verification, prior authorization and payment posting are separate services that can run alongside it as one revenue cycle program.
    Can your teams work in our clearinghouse and practice management system?
    Yes. We are platform-agnostic and train to your systems and payer portals rather than moving you onto ours.
    Is outsourced claims processing HIPAA compliant?
    Yes — signed BAAs, privacy training, controlled system access and documented handling procedures for PHI, under certified security standards.
    What's the difference between a rejected claim and a denied claim?
    A rejected claim never entered the payer's adjudication system — it failed a front-end format or data edit, so it produces no remittance advice and carries no appeal rights. Correct the data and resubmit it as a new claim. A denied claim was adjudicated and refused, arrives with a remittance and a reason code, and has appeal rights with a filing deadline. The two need different workflows, and teams that treat them as one thing tend to appeal claims that only needed a corrected field, and resubmit claims that needed an appeal.
    How do you reduce denials?
    By scrubbing against payer-specific rules before submission, following up before claims age, and tracking denial reason codes so recurring causes get fixed rather than reworked every month. Where the cause sits upstream in coding or eligibility, we tell you that instead of absorbing the rework indefinitely.

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