Manual DME billing is exhausting. Denials are common, cash flow is unpredictable, and most teams are stretched thin. But what if you could reduce denials by 30%—before the claim even leaves your system?
With automation now poised to handle 80% of healthcare admin tasks by 2029 (Notable, 2025), DME providers who adopt closed-loop workflows will gain a competitive edge.
Automation can help them achieve this by bringing claim submission, processing, and denial management into a seamless, closed-loop workflow.
Overcoming a Disconnected Billing Process
In 2025, many DME providers still rely on manual workarounds or siloed tools to submit and process claims. This fragmented approach leaves staff to manage complex billing tasks on their own, leading to denials and unpredictable cash flow.
“If providers don’t have a comprehensive platform or they’re leaning on multiple tools, they’re relying on their own knowledge,” says Chris Delposen. “Maybe they use Excel to track counts, but it’s largely manual.”
This lack of integration makes errors inevitable. Kelsey Kansler puts it like this: “Historically, as claims are coming in with denials, it’s a one-by-one investigation to determine the cause. It takes critical thinking to figure out what went wrong and then take the next step.”
When systems are “Frankensteined” together, something as simple as a change in a patient’s insurance doesn’t translate across systems. As a result, staff must rely on manual workarounds that automation could easily eliminate. To help illustrate this, let’s dive into automation’s role in each part of the claims submission process.
Front-End: DME Claim Submission Automation
The best way to avoid denials is to stop them before they start. Front-end automation catches errors and fills in key details during claim preparation so that submissions are accurate from the start. Let’s take a look at how.
Document Parsing and Data Extraction Tools
Instead of manually typing patient information, HCPCS codes, or authorization numbers over and over again, you can use a tool like TrueSight (Medbill’s AI-powered billing platform) to collect that information from faxes, scanned physician orders, or PDFs.
“Right now we’ve automated the first step—identifying the right patient for incoming faxes and tagging them automatically,” says Delposen. “The ability to search for an HCPCS code or other data points is built into the file, which makes prep far faster.”
TrueSight offers this capability, but tread cautiously if you’re considering other options—HIPAA-compliant parsing is a rare offering.
Related: What the HIPAA NPRM Means for DME Providers—and How to Prepare Now
Real-Time Validation Checks
Submitting a claim without proper validation is like mailing a letter without verifying the address; it’s likely to come back.
Real-time validation checks help by scanning claims for common errors (missing modifiers, expired authorizations, invalid NPIs, or mismatched codes) before submission. These rules-based checks run instantly in the background, so staff don’t have to manually double-check every field.
“Submission happens in two phases—first to the clearinghouse, then to the payer,” Delposen explains. “TrueSight runs validation rules before the clearinghouse step, so providers can fix errors before the claim ever leaves their system.”
In practice, this means staff get an alert the moment something is wrong. Instead of waiting days (or weeks) for a claim to be rejected, they can correct it on the spot.
Payer-Specific Edits
Every payer has its own requirements. The right tool can help you adhere to them by applying formatting rules automatically.
“Think of this as prior authorization requirements,” says Delposen. “If we know a payer requires a number on the claim, TrueSight automatically holds the invoice and flags the issue with a warning. It tells the user exactly what’s missing, so nothing slips through.”
In-Process Automation: Real-Time Visibility and Intervention
Once a claim has been submitted, automation provides visibility into where it stands. This saves billing teams from chasing claims blindly and helps them act before small problems turn into denials.
Claim Status Monitoring
After a claim is submitted, keeping track of its progress can be a headache. Many teams still rely on logging into payer portals, making phone calls, or maintaining spreadsheets to see whether claims are moving forward. These methods work, but they’re time-consuming and error-prone.
Automated monitoring removes that burden by tracking claims in the background and flagging anything that stalls or gets rejected. Billing teams get alerts right away, giving them time to resolve issues before they become hard denials.
Automated Claim Processing
Automation can also help clean up claims after submission. “For example, if a customer’s order lists an HCPCS twice, TrueSight automatically combines it into a single code before it goes out,” Delposen says. “That’s one less error that could cause a rejection.”
In TrueSight, the system doesn’t stop at claim rejections. “We also automate secondary billing so providers don’t have to manually resubmit when the primary kicks it back,” Delposen notes.
Automated ERA Processing
Electronic Remittance Advice (ERA) is the communication sent back from the insurance company that explains how a claim was processed—whether it was paid, partially paid, or denied.
For providers without advanced tools, managing ERAs means reviewing payer reports, logging details in spreadsheets, and routing tasks to staff for follow-up—a slow process that leaves room for things to slip through the cracks.
TrueSight automates this process by allowing users to set up configurable rules that trigger actions automatically, eliminating much of the repetitive work.
“We can define workflow steps so that whenever something comes in on an ERA in a certain way, it’ll automatically move it,” Kansler explains. “That takes repetitive manual work off the team’s plate.”
Delposen emphasized the flexibility of TrueSight, saying, “This is another unique capability—configurable ERA rules. It lets users tailor the automation to their own workflow.”
Back-End Automation: Stronger Denial Management
Even with preventive steps in place, denials still happen. Back-end automation makes it easier to track, log, and resolve them, while also building insights that strengthen future claims.
Denial Tracking Dashboards
Imagine having access to a dashboard that captures every denial code, reason, and resolution—no more sifting through endless spreadsheets or trying to interpret denial patterns on your own.
Advanced billing platforms (including TrueSight) already offer this kind of reporting, making it easier than ever for teams to have a source of truth for claim denials.
“TrueSight gives billing managers instant visibility into patterns without having to dig through spreadsheets or cross-reference multiple reports manually,” Delposen explains.
Automated Workflow Logging and Follow-Up
Managing claim denials manually often means digging through spreadsheets, sending reminder emails, and hoping nothing slips through the cracks. Automated workflow logging simplifies this by recording denials, assigning follow-up tasks to staff, setting due dates, and tracking progress in real time.
“In TrueSight, it’s not just automated logging,” says Delposen. “Users can create tasks with due dates and assign them to staff. That way, nothing gets lost, and managers have visibility into bottlenecks.”
Appeals Management Tools
Appealing a denied claim used to mean drafting individual letters, tracking multiple deadlines, and manually referencing coverage policies or LCDs. With the right software, you can streamline this process and ensure appeals are thorough and compliant.
“Instead of sending back a note that basically says, ‘You didn’t pay this, fix it,’ tools can help craft a professional, well-documented appeal,” says Kansler. “They can reference the LCD and compliance documentation so the claim has a much stronger chance of being overturned.”
The most advanced platforms can pull relevant payer rules, attach supporting documentation, and even suggest best practices for phrasing, allowing staff to work more efficiently while strengthening each appeal.
The Closed-Loop Advantage for DME Providers
When claims, processing, and denials are connected in a single workflow, your team benefits at every stage:
- On the front-end, claims are submitted correctly the first time, with patient eligibility and authorizations verified automatically.
- After submission, issues are identified and addressed before they become denials, while automated alerts keep tasks on track.
- On the back-end, denials are tracked and resolved more quickly, with real-time insights that accelerate reimbursements.
The result? Less manual work, fewer denials, stronger cash flow, and more time to focus on patient care.
If this sounds like a workflow your business could benefit from, take the first step—get in touch with one of our revenue cycle management consultants.
Or, keep reading: DME Billing Software Integrations: The Key to Quick, Clean Claims