Documentation/Billing & Insurance
Module guide · Financial
Billing & Insurance
Clinical charges get reviewed and grouped into invoices, invoices go out to patients and insurers, claims move through submission and appeal, and payments and installment plans bring the balance to zero.
What this module is for
Most screens share one billing-tier role gate; two also open to registration and physician roles.
Who uses it
Super admins, admins, directors, CFOs, billing, and billing managers/staff can use every screen. Eligibility and Insurers & Coverage also open to registration and physician roles, since those two are often checked at the point of scheduling or check-in.
Where to find it
Open Billing & Insurance from the sidebar. A dashboard, plus Invoices, Charge Capture, Chargemaster, Claims, Eligibility, Insurers, Payments, and Payment Plans.
- 1
Capture the charge
Clinical activity generates charges automatically; billing staff review, hold, or release them before grouping into an invoice.
- 2
Bill it
Post the invoice, then submit any insurance claims tied to it.
- 3
Follow the claim
Track it through submission, denial, appeal, or rebilling, watching the timely-filing deadline.
- 4
Collect
Post payments as they arrive, reconcile cash daily, or set up an installment plan for patients who can't pay in full.
A few terms you'll see throughout
Dashboard
A one-screen read on revenue cycle health, five rows of stat tiles plus an aging chart.
Stat tiles (red-highlighted when they signal a problem)
| Field | What it means |
|---|---|
| Total A/R, Invoices Overdue, In Collections, Draft Invoices | |
| Claims Submitted Today, Pending, Denied, Timely-Filing Risk | |
| Payments Posted Today, Insurance/Patient Payments (Month), Pending Charges Value | |
| Clean Claim Rate, Denial Rate, Avg Days to Payment, Collection Rate | Denial Rate warns above 10%. |
| Active Payment Plans, Overdue Installments, Autopay Due Today |
An A/R Aging chart (Current through 120+ days), a Charge Capture panel (Pending/Held), and Claims Appeal Activity.
Invoices
The core screen for billing a patient.
"New Invoice" form
| Field | What it means |
|---|---|
| Patient, Invoice Type* | Type: Professional, Institutional, Dental, Pharmacy, DME, Home Health, Hospice, Ambulance, or Lab Outreach. |
| Invoice Date, Due Date | Due Date defaults 30 days out. |
| Line Items* | Repeatable: CPT code, Description, Quantity, Unit Price. Total computes live. |
An invoice starts Draft; Post issues it. Void (before payment) and Write off (after partial billing) both require a typed reason.
Draft —
Issued —
Partially Paid —
Paid —
Disputed / In Collections —
Voided / Cancelled —
Charge capture
Where clinical charges are reviewed before they're grouped into an invoice.
Two tabs, Unbilled and Held. Hold (with a reason) pauses a charge from billing; Release returns it; Group to invoice bundles all of an encounter's charges into one invoice. Post Charge manually adds one for a patient/encounter.
Chargemaster
The master price list, standard, self-pay, and Medicare rates per procedure.
"New Item" form
| Field | What it means |
|---|---|
| CDM Code, Description* | |
| Standard Charge, Self-Pay Charge, Department, Effective Date |
Price File exports the price-transparency file. Deactivating an item is a soft-delete, it keeps history but can't be selected for new charges.
Insurance claims
Track a claim from submission through payer response, denial, and appeal.
Quick views for Timely-Filing Risk, Pending ERA, and Appeals At Risk. Actions: Submit, Deny (CARC code + reason), Appeal, Rebill, Void, and a full Status History. Claims can flow to a secondary insurer after the primary processes them.
Draft / Ready to Submit —
Submitted / Pending / Acknowledged —
Approved / Paid —
Denied —
Appealed —
Eligibility
Real-time X12 270/271 checks confirming a patient's coverage before or during a visit.
Verify Now checks one coverage; Batch Verify Today's Visits checks everyone scheduled today at once. Results show deductible met, out-of-pocket met, and copay. A Coverages Expiring Within 30 Days table flags lapsing insurance to follow up on.
Insurers & coverage
The payer directory and per-patient coverage priority, in one screen with two tabs.
The Insurers tab maintains the directory (name, payer ID, ERA enrollment, timely filing days). The Patient Coverage tab shows a patient's coverages ranked Primary/secondary/tertiary; Set Primary re-ranks them, determining billing order.
Payments
Post payments, handle refunds and returns, and reconcile cash daily.
"Post Payment" form
| Field | What it means |
|---|---|
| Invoice ID, Amount, Method* | Method includes Cash, Card, Check, ACH, EFT, and payer-specific options like Medicare/Medicaid/Tricare. |
| Payment Date, Reference # |
The Cash Reconciliation panel compares Posted vs. Deposited for a chosen day, flagging any Variance. Mark Returned handles bounced checks; Void reverses a payment entered in error.
Payment plans
Installment arrangements for patients who can't pay their balance in full.
"New Plan" form
| Field | What it means |
|---|---|
| Patient, Outstanding Invoices* | Checklist of the patient's open-balance invoices to include. |
| Total Amount, # Installments, Down Payment, Start Date | Installments default to 6. |
Lifecycle: Pending Approval → Approve → Activate. Pause and Default both require a reason; Run Autopay Sweep processes all due installments across every active plan at once.
Good practices
Run eligibility checks the morning of, not after the visit
Watch the Timely-Filing Risk queue daily
Void only works before payment; write off only forgives what's owed