Claims Submission Phase
From intake to payer - submitting clean, complete claims at scale with zero tolerance for preventable rejections.
Prevent Rejections Before Claims Reach the Payer
Claims submission is where revenue is made or lost before a payer even touches the file. Factum automates the entire submission pipeline - scrubbing, validating, formatting, and transmitting claims with accuracy that prevents front-end rejections and accelerates payment timelines.
Automated Claim Scrubbing
Every claim is validated against payer-specific edits, NPI requirements, and coding rules before submission. Errors caught and corrected before they reach the payer.
Payer-Specific Formatting
The platform maps each claim to the correct payer portal, EDI format, and submission protocol. The right claim goes to the right destination in the right format, every time.
Real-Time Submission Tracking
Every claim is tracked through acknowledgement and acceptance. The system monitors clearinghouse confirmations, payer receipts, and response timelines automatically.
Claims Submission Pipeline Sandbox
Adjust batch volume and payer rule accuracy to simulate live claim flow across all three pipeline stages. Watch the First-Pass Clean Claim Rate and AR metrics respond in real time.
First-Pass Clean Claim Rate
97.8%
99% payer rule accuracy
Est. Days in AR Saved
12d
vs. manual submission baseline
Auto-Fixed Rejections
216
of 264 total rejections
Avg. Days in AR
33d
from submission to payment
Claim Data Control Panel
Adjust inputs to simulate pipeline behavior
Payer Rule Accuracy
Live Simulation
Cards animate between columns in real time based on your settings.
💡 Hover over scrubbing claims to manually reject them.
Actionable Worklists | The "How" of Claims Submission
Your billing team operates from prioritized, intelligent queues - not spreadsheets.
Submission Ready Queue – Claims Cleared for Transmission
Claims that passed all scrubbing and validation checks are staged awaiting batch transmission or immediate submission based on payer timing rules.
Trigger Action:
The platform auto-batches claims by payer, submission window, and claim type - then transmits and records acknowledgement codes for every file sent.
Rejection Resolution Queue – Recovering Front-End Failures Fast
When a clearinghouse or payer rejects a claim, it is immediately routed with the rejection reason code, suggested correction, and resubmission deadline pre-populated.
Trigger Action:
Staff correct and resubmit within the same workflow - no system switching. Repeat rejections are escalated to supervisors automatically.
Pending Acknowledgement Queue – Monitoring Payer Acceptance
Claims awaiting payer-level acknowledgement are tracked in a dedicated queue. Staff are alerted when expected response windows are exceeded.
Trigger Action:
Upon receipt of a 277CA acceptance, the platform moves the claim to Payment Posting and begins the adjudication tracking clock.
Integrated Technology | How Claims Submission Is Powered
EDI Engine
Factum's EDI engine supports 837P, 837I, and 837D transaction sets with full HIPAA 5010 compliance. Claims are generated directly from clinical and billing data - no manual data entry required.
Payer-specific rules are maintained in a continuously updated library, ensuring submissions conform to each payer's unique formatting requirements without manual configuration.
Clearinghouse Integration
The platform connects directly to major clearinghouses for real-time submission, rejection response, and acknowledgement tracking - all within a single unified interface.
Clearinghouse-level rejection analysis surfaces patterns across payers and coding staff, enabling systematic improvements that reduce your first-pass rejection rate over time.
The Transition | From Submission to Payment Posting
A claim advances to Payment Posting once the payer has adjudicated and issued a remittance. The platform automatically receives 835 ERA files, matches them to open claims, and initiates the posting workflow - with zero manual intervention for clean payments.
Automatic Trigger |
Upon receipt of an ERA, the platform matches the payment to the corresponding claim, posts the allowed amount, and flags any underpayments or contractual variances for the Denial Management queue.