Faster Claims. Fewer Denials. Every Payer, Every Time.
TMS handles the complete insurance claims lifecycle — submission, follow-up, prior auth, denial appeals, and EOB reconciliation — so your revenue isn't held hostage by payer delays.
Is Your Claims Process a Revenue Bottleneck?
Insurance claims failures are rarely random — they follow predictable, fixable patterns.
High Rejection Rates
Front-end edits failing at clearinghouse due to eligibility errors, missing modifiers, or wrong payer IDs — preventable with the right process.
Prior Auth Delays
Authorisation requests lost in payer queues causing treatment delays, provider frustration, and patient satisfaction damage.
Denial Inbox Overload
Staff overwhelmed by denial volume — working highest-dollar claims only and abandoning thousands in small-balance revenue.
No Appeal Strategy
Generic appeal letters sent once and forgotten. Most denials require a tailored, payer-specific approach to overturn successfully.
Complete Claims Management by TMS
From pre-submission scrubbing to final resolution — every claim managed, every denial pursued.
Pre-Submission Claim Scrubbing
Every claim checked against payer-specific rules before submission. Catch errors before they become denials.
Prior Authorisation Management
PA requests submitted, tracked, and escalated. Automated alerts for approvals, denials, and expiring auths.
Electronic & Paper Claims Filing
Claims submitted via EDI to 900+ payers and paper-filed for those requiring it. No payer left unsupported.
Denial Analysis & Appeals
Denial root-cause analysis + tailored appeal letters with supporting clinical documentation for maximum overturn rate.
EOB & ERA Reconciliation
Remittances posted and reconciled within 24 hours. Payment discrepancies identified and escalated before close.
Underpayment Identification
Systematic contract rate verification catches payer underpayments that most organisations never detect.
Roles We Fill
Every role is pre-vetted, HIPAA-trained, and ready to integrate into your workflows within two weeks.
Discuss Your Staffing NeedsFrom Contract Signed to Fully Operational in 4 Steps
Claims Audit
We review 90 days of claims data and identify your top denial codes, payer patterns, and rejection triggers.
Payer-Specific Setup
Workflows built around your exact payer mix — commercial, Medicare, Medicaid, and specialty payers.
Go Live
Team begins processing claims within 10 business days. Real-time dashboards available from day one.
Continuous Improvement
Weekly denial reports highlight emerging patterns for protocol updates before they become expensive trends.
Common Questions About Insurance Claims Processing
TMS processes medical, dental, and behavioural health claims across all payer types — commercial insurance, Medicare, Medicaid, CHIP, workers' compensation, and auto/liability insurance. We support both professional (CMS-1500) and institutional (UB-04) claim formats.
TMS manages the entire prior auth workflow: determining auth requirements by CPT code and payer, submitting requests via phone, fax, portal, and EDI, tracking approval status, uploading clinical notes when required, and alerting your team to outcomes. We maintain a live auth tracker updated daily.
Our average denial overturn rate is 68% for clinical denials and 85% for technical/administrative denials. Overall, we recover approximately 72% of initially denied claim value that is pursued through appeal, compared to an industry average of around 45%.
Yes. We work directly within your existing PM/billing system rather than requiring data migration or a new platform. We request appropriate user access through your IT department and follow your established security protocols.
We provide credentialing support including CAQH profile maintenance, payer enrollment applications, re-credentialing tracking, and provider roster updates. Full credentialing management is available as an add-on service.
Ready to Transform Your Insurance Claims Processing?
Join 200+ healthcare organisations that have cut costs, reduced errors, and freed their clinical teams to focus on what matters most — patient care.