Claims

What it does

Here is what it does.

Who it is for: For the biller or office manager.

• Adds or removes procedure lines from the practice fee schedule, with the fee.
• Locks and unlocks the coding worksheet. A claim cannot go while it is unlocked.
• Checks the claim before it goes: codes locked, assignment of benefits signed, coverage checked, member id present, date of service not in the future, a diagnosis on file, every line pointed at a diagnosis, and the onset date (box 14) when it is required.
• Sends a clean claim and records the payer’s acceptance and control number, then posts the payer’s payment.
• Issues a patient statement for self-pay instead of an insurance claim.
• Looks up a code’s meaning and fee.

How it works

1. A person adds the lines and says "lock Elena."
2. Say "scrub Elena." She lists every problem, such as "Box 14 onset is empty."
3. Fix each one, scrub again, and see "Clean."
4. Say "submit Elena." The claim shows accepted, and later paid when the payment is posted.

The connection

Claims clearinghouse

What it connects

The claim to a clearinghouse that forwards it to the payer.

What moves

The claim out, then the acceptance, the coverage answer and the payment back. Nothing it sends is kept.

What you do

Lock the codes, fix what the check finds, and say submit.

What happens on its own

The pre-send check and the status changes.

What it needs

Your team connects a clearinghouse. Today the send runs on the made-up practice and no real claim leaves.

Sign-in

One sign-in.

Staff use the same Stinger sign-in as Command Center. Signing in opens that person’s Firm portal, Practice, or House.

Please read

• She never chooses a procedure code, a diagnosis code or a visit level.
• Demo data: no real claim leaves until a clearinghouse is connected.

Please read. Practice is office software, not medical advice. Annabelle does not practice medicine. Your EHR stays the medical record. Annabelle is an AI and can be wrong. Check anything that matters before you rely on it.