Billing / Denials

What was refused, why, and how much is still collectable.

The 835 remittance file a payer sends is the most complete account of a practice’s money — and a wall of asterisks. Loaded here, it becomes a worklist grouped by what to do, with contractual write-offs separated from money still worth chasing.

Try it in the live demo All modules

The denial report: charged, paid and still-collectable totals for 90 days, collectable money grouped by what to do, and the reason codes costing most with plain-English explanations. — Remittance files turned into what was refused, why, and what is still worth chasing. Shown with sample data.

What it does

Denials, in practice

Reads the 835

Load the X12 835 remittance file a payer sends. Loading the same file twice is recognised, and nothing is counted again.

Reasons in plain English

About twenty common reason codes are explained and filed under what to do — fix and resubmit, appeal, bill the patient, write off, or needs a look. Anything else is flagged, not guessed.

Collectable, separated

Contractual write-offs are kept apart from money still worth chasing, and the claims to deal with are listed largest first.

Where the money went

A report over any period up to a year: collectable money by action, the reason codes costing most, and charged, paid and denied by payer.

Bill the patient’s share

One click turns a patient balance into a payment request, with Payments switched on.

Back onto the claim

Results post back to claims built in Claim scrubbing when the claim number and amount match.

How it works

From the first step to the last

1
Load
Upload the payer’s 835 file.
2
Sort
Each denial is explained and filed under what to do about it.
3
Work
Fix, appeal, bill or write off — and mark each one dealt with, with a note.

What it needs

Before you switch it on

Nothing elseWorks on its own, with or without an EMR connected.

Every module switches on and off by itself, per clinic, with its own screens, permissions and audit trail.

Worth knowing

It needs no EMR at all — it works from the remittance file alone, which makes it the revenue feature that works for every clinic on the first day. Reason codes outside its list are marked for a person rather than interpreted.

Goes well with