Claims processing
Claims from submission to payment, with denials worked as a queue rather than discovered later.
A claim has a life: submitted, accepted or rejected at the clearinghouse, adjudicated, paid or denied. Money is lost in the gaps between those states, usually because a denial sat unworked until the appeal window closed.
This page tracks every claim through that life and holds denials in a worklist with the reason code, the deadline, and the dollars attached. Timely filing limits are counted down rather than assumed.
Where everything sits
How to work this page
A rejection at the clearinghouse never reached the payer. It is faster to fix and it does not consume the filing window, so it is worked ahead of denials.
The queue sorts by remaining days in the appeal window. A large denial with sixty days left is less urgent than a small one with four.
Codes group into what is appealable and what is not. Repeated codes point at a submission problem upstream that is worth fixing once rather than appealing weekly.
Payments post against the claim with the adjustment detail, so the difference between billed, allowed, paid and patient responsibility is visible per line.
On a phone
Every figure from the desktop appears here, stacked rather than reduced. Tables scroll inside themselves so the page never moves sideways, and figures keep their separators and their alignment at every width.
Questions people actually ask
No. It reads the responses and manages what happens after them. The clearinghouse relationship stays where it is.
Separated from payer responsibility at remittance so the amount you can actually bill a patient is distinct from the amount an insurer adjusted away, which you cannot.