What we do / ClaimsINCLUDED
Every claim checked, sent and tracked
Clean claims go to the insurance company through a clearinghouse. Sent, accepted, rejected and paid are tracked as separate steps, and rejected claims are fixed and resent by your billing team.
Who does what
Who does what with claims
Software
Software
- Builds and scrubs each claim and holds any claim that fails a check.
- Tracks each payer's filing deadline.
Your billing team
Your billing team
- Fixes and resends claims that the clearinghouse or the insurance company rejects.
- Sends the secondary claim after the primary insurance pays.
You
Your practice
- Your clinicians sign notes on time, so visits can be billed.
- Your front desk gets patient and insurance details right at intake.
- You sign claim and remittance enrollment forms as the practice's authorized official when an insurance company needs them.
Client dashboardSample clinic · Physical therapy · 2 locations
SAMPLE DATAFictional clinic. Synthetic numbers.Updated Mon Sep 28, 6:00 pm
Claims board
Sample clinic
Sample view with synthetic data. The client dashboard is planned; this shows what it will track.
Checking22$2,439.88 openSoftware, checked by your billing teamVisit documented or note pending. Codes, units, modifiers, plan of care and coverage are checked before the claim goes out.
Sample shows 3 per column
With payer295$28,719.34 openSoftware; your billing team follows up if the payer is lateSent and accepted; waiting for the payer's decision.
Sample shows 3 per column
Total open: 619 claims, $43,003.11. Equals Open A/R.
What happens to a claim
Four steps, each tracked on its own
A claim is not done when it is sent. Acceptance and payment are separate steps, and each one is tracked.
- Step 1
Checked
Each claim is checked for required fields, payer IDs, code pairs, authorization dates and the filing deadline. A claim that fails a check is held for your billing team.
Software
- Step 2
Sent
Clean claims go to the insurance company through a clearinghouse.
Software
- Step 3
Accepted, or rejected, fixed and resent
Acceptance by the clearinghouse and the insurance company is tracked as its own step. Your billing team fixes and resends a rejected claim. A rejection is not a denial: the claim was never decided.
Your billing team
- Step 4
Paid
Payment is tracked separately from acceptance, and the payment is matched to the visit in payment posting.
- Duplicates are blocked before they go out.
- Secondary claims go out after the primary pays.
- We track each insurance company's filing deadline and work claims before it passes.
What the rules say
Medicare's clock on a claim
Two public rules set the pace for every Medicare claim: when it can be paid, and how late it can be filed.
Questions
Questions about claims
Your billing team fixes it and sends it again. A rejection by the clearinghouse or the insurance company is tracked as its own step, separate from a denial.
Yes. Your billing team sends the secondary claim after the primary pays.
We track each insurance company's filing deadline and work claims before it passes. Medicare's limit is one calendar year from the date of service.2