Every healthcare organization deals with insurance data entry services. It is the paperwork that connects the care a patient receives with the payment that follows. It might sound simple, but in reality, medical claims data entry management is one of the most complex parts of the healthcare system. When claims are denied, delayed, or contain errors, hospitals lose thousands and millions of dollars. In fact, 68% of providers say submitting “clean” claims is more challenging than it was a year ago, according to the 2025 Experian Health State of Claims Report.
Understanding claims data, what it is, its types, and how it’s used, is essential for anyone working in healthcare.
What is Claims Data in Healthcare?
Medical claims refer to the information that providers submit to health insurance companies when they request payment for services rendered to a patient. It covers large electronic records that capture interactions between patients, providers, and insurers. Millions of appointments, medical bills, and insurance submissions are routinely collected and stored in claims databases. Since most healthcare facilities do not have in-house resources to manage medical claims data entry, they outsource it to insurance data entry service providers. In today’s world, even artificial intelligence services and solutions are used to automate medical claims data entry processes. However, a human’s eye is always needed at the end to overlook the insights provided by AI.
Medical claims data typically includes:
- Diagnosis Codes (for example, the “ICD-10” codes). These help identify and classify diseases, injuries, and other health conditions.
- Procedure Codes (also called “CPT” codes, or Current Procedural Terminology). These are the standard medical billing codes used when providers bill insurers for the services given.
- National Provider Identifier (NPI). This is basically a provider’s unique identifier (kind of like their social security number in the healthcare world).
Service Dates. Simply when a service took place. Recording that helps with patient outcomes and also makes billing and internal processing smoother.
Different Types of Claims Data
There are two main types of claims data, and they originate from different points in the healthcare-utilization lifecycle. Each type gives insight into different things.
Open Claims
These are transactions that are still in progress or haven’t been fully resolved. In other words, medical services may have been provided to a patient, but the claim is still under review, adjudication, or reimbursement. Because they’re in process, these often reflect more real-time data. These open claims typically come from healthcare facilities that are tracking procedures, diagnoses, and encounters before the final settlement.
Closed Claims
These signify transactions that have reached their resolution: the claim has been processed, reviewed, and either reimbursed or denied. Closed claims represent completed encounters and give a complete picture of cost and treatments. They tend to come from insurers (who cover finances, coverage, and claims).
Advantages of Using Claims Data
Claims data carry several practical advantages that make it an essential resource for healthcare analytics. Since claims data entry services follow standardized templates and care codes, it ensures smoother processing of claims and more consistent results. Since the data can come from both payers and providers, it allows tracking of a patient’s journey across different healthcare settings and insurance plans, giving a 360-degree view of care provided.
An advantage of outsourcing medical claims data entry services is its cost-effectiveness. Since the insurance data entry service providers take care of everything, organizations don’t need to spend on extra resources or overburden their current ones. Outsourcing medical claims data entry services also helps in structuring the workflow and maintaining data security and compliance.
Disadvantages of Using Claims Data
Despite its advantages, claims data does come with its own set of limitations. It often lacks the detailed clinical context found in physician notes, such as specific symptoms, lab results, or imaging details, which restricts the depth of analysis. Integrating information from multiple providers or insurers can also be challenging, leading to fragmented datasets and incomplete patient profiles. Since medical claims data entry primarily focuses on billable services, it misses non-billable care or informal interactions, leaving gaps in the patient’s full healthcare journey.
Claims data can show that treatment was provided, but not necessarily how often or whether it was appropriate for the condition. It also excludes uninsured patients and cash transactions, reducing how representative it is of the entire population. Which is why, as discussed above, most healthcare providers choose to partner with a professional insurance data entry services provider to handle it all for them.
Claims data entry service providers address these challenges by seamlessly integrating data with electronic medical records (EMRs), registries, and broader health data ecosystems.
Why Outsource Claims Data Entry Services?
Many healthcare facilities lack the in-house expertise, technology, and manpower to handle medical claims data entry efficiently. Managing large volumes of complex data requires accuracy, consistency, and strict compliance standards such as HIPAA. The heavy load of work that comes with medical claims data entry is something that can strain internal teams that are already focusing on patient care. Outsourcing claims data entry services allows healthcare organizations to rely on trained professionals who specialize in data processing, reducing errors, improving turnaround time. This helps free up staff to concentrate on core clinical work. When you outsource claims data entry services to a provider such as Rannsolve, which specializes in artificial intelligence services and solutions, you tap into specialist expertise and a structured workflow.
Rannsolve, Your Professional Claims Data Entry Services Partner
With 25+ years of expertise in healthcare services, Rannsolve offers comprehensive claims data entry services and insurance data entry services designed to simplify and improve data management for healthcare organizations. Our medical claims data entry specialists handle data entry and validation with accuracy while maintaining compliance standards. Talk to our claims data entry expert now.
FAQ
Insurance data entry services involve recording and organizing insurance-related information into digital systems. This process ensures that policy, claim, and billing details are stored accurately for easy access and processing.
In medical terms, claims data refers to the information healthcare providers send to insurers for payment. It includes details about treatments, diagnoses, and services managed through medical claims data entry.
Claims data entry is the process of entering patient, provider, and insurance details into healthcare systems. It is handled by professionals offering claims data entry services to maintain accuracy and compliance.
Medical data entry means entering and updating patient records in digital systems. It can be automated through artificial intelligence services and solutions to improve accuracy while reducing manual effort.
