If you’re tired of waiting weeks (or months) for insurance payments, you’re not alone. Most clinics spend way too much time chasing claims, fixing avoidable mistakes, and playing phone tag with payers. This guide is for anyone using Eclinicalworks who wants to spend less time on billing headaches and more time actually getting paid.
Below, I’ll walk you through a practical, no-nonsense approach to getting claims out the door faster—and getting those reimbursement checks in your hands sooner.
Step 1: Clean Up Your Patient and Insurance Data
Let’s start with the most boring (and most important) part: clean data. Nearly every denied or delayed claim can be traced back to bad info—think misspelled names, outdated insurance IDs, or wrong dates of birth.
What you should do:
- Standardize registration: Train front desk staff to verify and enter patient info exactly as it appears on the insurance card. Every time.
- Check insurance eligibility: Use Eclinicalworks’ real-time eligibility tools before every visit. Don’t assume coverage hasn’t changed just because it was fine last time.
- Set up required fields: Make as many fields as possible mandatory for registration in your system. Missing info is the fastest way to a denied claim.
Pro tip: Don’t rely on patients to know their insurance details. Ask for the card and check it yourself.
Step 2: Get Your Providers and Coders on the Same Page
No one likes coding, but mistakes here are expensive. If your clinical notes are too vague or codes aren’t updated, claims will bounce back.
What works:
- Use templates and macros: Eclinicalworks lets you set up templates for common visits. Use them to prompt for required documentation.
- Stay current on coding: Make sure your coders have the latest CPT, ICD-10, and HCPCS updates. Eclinicalworks updates code sets, but it’s easy to get behind.
- Flag missing or conflicting info: Set up alerts in Eclinicalworks for incomplete documentation or code mismatches.
What doesn’t:
Assuming your providers will “just know” what’s needed for billing. If you don’t spell it out, it’ll get missed.
Step 3: Make Friends with Eclinicalworks’ Claim Tools
Eclinicalworks isn’t perfect, but its billing module is powerful if you actually use it. Most clinics barely scratch the surface.
How to get the most out of it:
- Batch claims every day: Don’t wait until Friday to send out five days’ worth of claims. Set aside 10 minutes daily to review and submit.
- Use claim scrubbing: Eclinicalworks can flag missing info, invalid codes, or format errors before you send the claim. Make sure this is turned on (some clinics skip it or ignore the warnings).
- Set up payer rules: Customize Eclinicalworks to catch payer-specific quirks—like certain payers requiring extra modifiers or attachments.
What to ignore:
The urge to customize every workflow to the nth degree. Stick to the basics until your claims are flowing smoothly.
Step 4: Automate What You Can (But Don’t Trust It Blindly)
Eclinicalworks promises a lot with automation—auto-posting payments, auto-generating claims, electronic remittance, and so on. These are helpful, but they’re not set-and-forget.
What’s worth automating:
- Eligibility checks: Have these run automatically before each visit.
- Claim creation: Automatically generate claims from closed encounters, but review them before sending.
- ERA (Electronic Remittance Advice): Set this up so payments post themselves, but always reconcile with your bank deposits.
What needs human eyes:
Denials, exceptions, and anything with a weird note or adjustment. Automation is great for routine stuff, but it won’t catch edge cases.
Step 5: Track Denials and Fix the Root Cause
Every denied claim is an opportunity to tighten things up. The trick is to actually look at denial reasons—not just resubmit and hope for the best.
How to do it in Eclinicalworks:
- Run denial reports weekly: Eclinicalworks has reports that break down denials by type, payer, and reason.
- Set up workflows for follow-up: Assign denied claims to specific billers, and track their status until resolved.
- Look for patterns: If you’re seeing the same denial reason over and over (like “invalid diagnosis code”), fix your process, not just the claim.
What doesn’t work:
Blaming the payer for every denial. Sure, sometimes it’s their fault, but most of the time, there’s a fixable issue on your end.
Step 6: Train (and Retrain) Your Team
Most billing mistakes come down to people, not software. So don’t skimp on training.
Tips that actually help:
- Regular, short training sessions: Fifteen minutes a month is better than a three-hour annual lecture everyone forgets.
- Cheat sheets for tricky payers: Keep a shared doc with tips for each insurance company. Update it often.
- Show your team the money: When claims are paid faster, let staff see the results. It motivates people more than you’d think.
What to skip:
Overloading your team with endless “best practices” that never get used. Keep it practical.
Step 7: Stay in Touch with Your Clearinghouse and Payers
Don’t just fire claims off into the void. If claims are delayed or rejected, get someone on the phone.
How to avoid the black hole:
- Check claim status electronically: Use Eclinicalworks’ claim status tools and your clearinghouse portal. Don’t wait for weeks to pass.
- Escalate persistent issues: If something’s not getting resolved, escalate with the payer. Document everything.
- Keep a contact list: Have up-to-date contacts for your main payers and clearinghouse. When you need them, you’ll really need them.
What to ignore:
Assuming “no news is good news.” Silence usually means something’s stuck.
Step 8: Keep Your Eclinicalworks System Healthy
Even the best workflows break if your software’s out of date or misconfigured.
What you should actually do:
- Apply updates promptly: Eclinicalworks fixes bugs and updates code sets regularly. Don’t put off updates for months.
- Audit your setup once a year: Have someone (internal or external) check your templates, payer rules, and automations.
- Back up everything: This should go without saying, but don’t trust any cloud system to be infallible.
What’s not worth your time:
Chasing every new feature or add-on. Focus on the basics unless you have a specific, well-defined problem.
Wrapping Up
Getting paid faster isn’t about chasing every silver bullet or fancy feature—it’s about doing the boring, basic things well and fixing problems when they pop up. Make small changes, see what works, and don’t let things pile up. Start with clean data, use the tools you have, and keep your team in the loop. Iterate, don’t overcomplicate, and you’ll see the money come in sooner.