Focused.Accurate.Compliant.

Medical Billing Services for U.S. Practices

MediFlows Billing Solutions is a nationwide medical billing service handling coding, claim submission, denial management, and AR follow-up for practices in all 50 states. We start with a 30-day denial audit: a one-page report naming your top five denial reasons and the dollars stuck in each, delivered by day 7, before you sign anything.

Denial audit delivered day 7

Before you sign anything

Your top 5 denial reasons, named

All 50 states

Our Services

WELCOME TO MEDIFLOWS

What a medical billing service should hand you in the first month

Most billing companies start with a contract and show you results a quarter later. We start with a diagnosis. Your first deliverable is a one-page report on your last 30 days of claims: the five reasons payers gave for denying them, and the dollar amount sitting behind each reason.

That report is useful whether or not you hire us. If your largest denial category is a registration problem, no billing vendor fixes that for you. Your front desk does. You should know which one it is before you pay anyone.

After the audit you get a live claim dashboard, refreshed daily. Not a monthly PDF. A daily view of what has been submitted, what has been paid, and what is stuck.

OUR PROCESS

The 30-day onboarding schedule

Day 1

Kickoff and access review across your EHR, PM system, and clearinghouse

Day 7

30-day denial audit delivered: top five denial reasons and dollars stuck in each

Day 14

Clean-claim protocol activated on new submissions

Day 30

Live claim dashboard running, refreshed daily

Most denials are administrative, not clinical

Practice owners tend to assume denials are arguments about medical judgment.

The payer-side data says otherwise.KFF’s March 2026 analysis of CMS Transparency in Coverage data, covering HealthCare.gov qualified health plans in the 2024 plan year, found that insurers denied 19% of in-network claims and 37% of out-of-network claims, for a combined average of 20% of all claims. Of the in-network denial reasons insurers reported, 36% were logged under “Other” with no reason specified, and 25% were administrative: duplicates, missing information, untimely filing, unapproved provider. Only 5% were based on medical necessity, and 9% were for lack of prior authorization or referral. A further 13% were for an excluded service.

Read that distribution again. The largest single category is a category that tells you nothing, and the largest category that does tell you something is paperwork.

Paperwork denials are the ones a billing service can actually move. Medical necessity denials require clinical documentation and a physician’s time. A duplicate claim or a missing subscriber ID does not.

The provider-side survey data points the same way. Experian Health’s State of Claims 2025 report, a survey of 250 healthcare professionals conducted in June and July 2025, found that 41% of providers say more than 10% of their claims are denied, up from 38% in 2024 and 30% in 2022. Sixty-eight percent said submitting clean claims is harder than it was a year ago, and 54% said claim errors are increasing. Twenty-six percent said at least one denial in ten at their organization traces back to errors made at patient intake.

The denial codes that carry most of the recoverable money

Code	What the payer means	Where it originates	Who owns the fix
CO-16	Claim lacks information or has submission errors	Patient registration and intake	Your front desk, with our checklist. We cannot prevent this from the outside.
CO-22	Coverage may be primary under another carrier	Eligibility check not run, or coordination of benefits missed	Shared. Our eligibility step catches most of it.
CO-29	Time limit for filing has expired	Claim sat in a work queue	Ours, fully, once we hold the queue
CO-45	Charge exceeds the contracted fee schedule	Your fee schedule or the contracted rate	Usually not a denial at all. It is a contractual write-off.
CO-50	Not deemed medically necessary by the payer	Clinical documentation	Your provider, with our appeal support
CO-96	Non-covered charge	Plan benefit design	Shared. Determines whether the patient owes the balance.
CO-97	Service is bundled into another paid service	Coding, usually an NCCI edit	Ours, fully

Only CO-29 and CO-97 are fully ours to prevent. We say that out loud because a vendor that tells you it can eliminate CO-16 either does not understand where CO-16 comes from, or is hoping you do not.

If you want the detail on the individual codes, we have written each of them up: what CO-16 actually means and how to fix it, why CO-97 is a bundling problem, not a coverage problem, why CO-45 usually is not a denial at all, how CO-22 coordination of benefits works, and who actually owes the balance on a CO-96.

Your Trusted Partner for RCM & Medical Billing

SERVICE 01 of 05

HIPAA-Compliant Medical Billing

Our expert billing team manages every step of your revenue cycle with precision — from charge entry and coding review to claim submission and payment tracking. We help reduce errors, minimize delays, and keep your practice revenue flowing.

SERVICE 2 of 05

Claims Management & Denial Recovery

Prevent revenue leakage with proactive claim monitoring, denial analysis, appeals management, and payer follow-up. Our team works directly with insurance companies to resolve issues and maximize your reimbursements.

SERVICE 03 of 05

Complete Revenue Cycle Management

From eligibility verification and medical coding to accounts receivable management and payment posting, we provide end-to-end RCM services designed to improve cash flow and financial visibility.

SERVICE 04 of 05

Medical Credentialing

Our medical credentialing services help providers get enrolled with insurance networks efficiently.

We manage applications, documentation, and payer requirements to keep the process moving smoothly.
Stay credentialed and focus on delivering quality patient care while we handle the paperwork.

SERVICE 05 of 05

Systems we work in

MediFlows works inside your existing EHR and practice management system rather than requiring a migration.

AdvancedMD · Allscripts · athenahealth · CollaborateMD · CureMD · DrChrono · eClinicalWorks · Kareo/Tebra · MedGen · NextGen · TherapyNotes · Office Ally

What the industry's numbers actually say, and who published them

Every figure on this page is reproduced below with its publisher, its year and its scope, so you can check it yourself.

Figure	Source	Vintage and scope
41% of providers report denial rates above 10%, up from 30% in 2022	Experian Health, State of Claims 2025	Survey of 250 healthcare professionals, June–July 2025
68% say clean claims are harder than a year ago; 54% say claim errors are rising; 26% trace one denial in ten to intake errors	Experian Health, State of Claims 2025	Same survey
In-network denial rates range 3% to 36% by insurer	KFF	Same dataset. Hawaii averaged 27%, South Dakota 7%. Texas insurers ranged 12% to 36%.
$25.20 average cost to rework a denied claim	MGMA	Published benchmarking
36% "Other", 25% administrative, 13% excluded service, 9% prior auth or referral, 5% medical necessity	KFF	Same dataset, plan-level denial reason reporting. A claim can carry more than one reason.
Fewer than 1% of denied claims are appealed; 66% of appeals are upheld by the insurer	KFF	Same dataset. 262,982 internal appeals against roughly 85 million in-network denials.
$43.84 per disputed claim (2022), $57.23 (2023), $118 for a formal appeal	Premier Inc.	Provider-reported administrative cost
19% of in-network claims denied; 37% out-of-network; 20% combined	KFF	March 2026 analysis of CMS Transparency in Coverage data, HealthCare.gov QHPs, 2024 plan year, 496 million claims from 157 reporting insurers
$50,250 median annual wage, medical records specialists	US Bureau of Labor Statistics	Occupational Outlook Handbook, May 2024

Only CO-29 and CO-97 are fully ours to prevent. We say that out loud because a vendor that tells you it can eliminate CO-16 either does not understand where CO-16 comes from, or is hoping you do not.

Our scale and reach to client satisfaction

90 +

Number of Clinics served by Mediflows Billing Solutions

80 +

hospitals have been served by Mediflows Billing Solutions

90 +

Number of Physio Therapists Served by Mediflows Billign Solutions

40 +

Vision Practices been served by Mediflows Billing Solutions

MEDIFLOWS SERVICES

Our Medical Billing Services

Our medical billing services help healthcare providers simplify billing, reduce claim denials, and improve revenue flow.
From claims processing to payment management, we handle the billing process so you can focus on patient care.

Credentialing and Enrollment

Streamlined medical billing services keep your providers fully compliant, connected, and reimbursed effectively.

Chronic Care Management services

We delivers end-to-end Chronic Care Management (CCM) services that improve outcomes for patients.

Revenue Cycle Management

Real-time eligibility verification confirms coverage and helps avoid claim denials upfront effectively.

Remote Patient Monitoring

Comprehensive RPM support with compliant billing, seamless patient onboarding, and clinical data tracking.

Denial Management Services

Expert denial resolution helps recover lost revenue and prevent future claim rejections effectively now.

Virtual Medical Assistant

24/7 virtual support for scheduling, calls, insurance checks, and EHR documentation tasks fully handled.

Insurance Eligibility Services

Real-time eligibility verification confirms coverage and helps avoid claim denials upfront effectively today.

Medical Coding Services

Certified coders ensure accurate, compliant ICD-10 and CPT coding for every specialty always perfectly.

The MediFlows Advantage

KEY FEATURE 01 of 03

Specialty and nationwide coverage

At MediFlows Certified coders work your claims, not a shared queue.

Certified coders, billers, and clinical staff with 20+ years in denial recovery

Deep expertise in Medicare, Medicaid, and commercial payer appeal protocols

HIPAA-compliant technology with real-time denial dashboards

We work in the practice management and EHR systems our clients already use.

Dedicated denial specialists assigned to your practice for consistent support

KEY FEATURE 02 of 03

Specialty and nationwide coverage

MediFlows bills for practices in all 50 states. Coverage is national because payer rules are not, and a billing operation working across state Medicaid programs and multiple MACs sees policy changes earlier than one working a single market.

Specialty billing differs at the code level, not the marketing level. Cardiology reimbursement turns on the documentation elements separating one echocardiography code from the next and on professional versus technical component splits. Behavioral health turns on time-based psychotherapy code accuracy against the clinical note. Rehab turns on unit rules. Those are different failure modes, and the specialty pages should say so.

KEY FEATURE 03 of 03

Switching from in-house billing or another vendor

A transition from in-house billing to MediFlows typically takes two to six weeks. Where a practice lands in that range depends on how clean the handoff is: system access, open AR at the cutoff date, and whether the outgoing biller is available to answer questions about aged claims.

We do not require a long-term contract. That matters most during a transition, because the period when a practice is least able to evaluate a billing partner is the period when a 24-month agreement locks it in hardest.

One thing to plan for is aged AR at the cutoff. Claims already denied before we take over keep burning their filing windows during the handoff. Decide explicitly who works them and put it in writing before day one.

We Support All Medical Specialties

Billing rules change from one specialty to the next. Our coders work to the payer rules, modifiers and documentation standards that apply to yours.

Family Medicine • Internal Medicine • Cardiology • Orthopedics • Neurology • Dermatology • Gastroenterology • Pediatrics • Psychiatry • Behavioral Health • Physical Therapy • Occupational Therapy • Chiropractic Care • Pain Management • Urgent Care • Radiology • Laboratory Services • Home Health • Urology • ENT • Ophthalmology • General Surgery • Anesthesiology

FAQ's about the Service

How much do medical billing services cost?

The 2026 market benchmark is 4% to 10% of net collections, with most small and mid-sized practices quoted between 5% and 8%. Per-claim pricing typically runs $3 to $12. The percentage is the wrong comparison on its own. Ask which of credentialing, coding, patient statements, clearinghouse fees, and appeals sit inside the fee and which get invoiced separately.

Is outsourcing medical billing cheaper than hiring in-house?

Not always. A three-provider practice running one certified biller costs roughly $85,000 to $92,000 a year in salary and benefits alone, using AAPC's 2025 average of $65,007 plus a 30% load, before software and denial rework. Outsourcing wins clearly when your denial rate is high. At a low denial rate with clean first-pass submission, the two are close.

What percentage of claim denials are actually preventable?

Most of them. In KFF's March 2026 analysis of 2024 CMS transparency data, insurers logged 36% of in-network denials as "Other," 25% as administrative, and 9% for missing prior authorization or referral. Only 5% cited lack of medical necessity. Administrative and authorization denials are preventable at submission. Medical necessity denials require clinical appeal work.

How long does it take to switch billing companies?

Two to six weeks for most practices moving from in-house billing to MediFlows Billing Solutions. The variable is access and open AR, not onboarding. Decide before the cutoff date who works claims already denied under the old process, because those keep aging against their filing deadlines during the handoff.

What is a good clean claim rate?

The widely used target for first-pass acceptance is 95% or higher. A clean claim rate above 95% does not eliminate denials, because medical necessity reviews, payer policy exclusions, and retroactive audits still hit claims submitted correctly. When a vendor quotes you a rate, ask what it measures: payer first-pass acceptance and clearinghouse acceptance are different numbers, and the second one is easier to make look good.

What happens to my old denied claims when I switch?

They keep aging. A Medicare claim must reach the MAC within 12 months of the date of service under 42 CFR § 424.44, and a timely filing denial carries no appeal rights. Medicare Advantage and commercial windows are shorter. Assign ownership of pre-transition AR in writing, with a date, before the new vendor starts.

Do I have to sign a long-term contract?

No. MediFlows Billing Solutions does not require a long-term contract. Before signing anywhere, ask what the termination notice period is and who owns your claim data on exit. Those two clauses matter more than the fee percentage.

What does the 30-day denial audit include?

A one-page report naming your top five denial reasons across your last 30 days of claims and the dollars stuck behind each, delivered by day 7 and sorted by payer as well as by reason code. It is a diagnosis, not a proposal. If your largest denial category is a front-desk registration problem, the report will say so, and that is a fix you can make without hiring anyone.

I am opening a new practice. When should billing start?

Before you see patients. Credentialing and payer enrollment run on payer timelines you do not control, and services delivered before enrollment completes are generally not billable to that payer. Practices that start credentialing after opening routinely lose the first several months of collections to enrollment gaps rather than to billing errors.