Claim status checks and denial follow-up in one work queue

Clearinghouse keys and portal credentials sit in an encrypted secrets store and are never written to logs. Portals are the last resort: we check each payer's terms first and automate only where they allow it. We do not bypass CAPTCHAs or bot detection; a payer that forbids automation stays on EDI, an API or staff.

The affected connector fails loudly, not silently: unexpected pages or responses stop it, alert us and leave its claims in the staff queue marked as unchecked. We then update the connector. Electronic routes such as the 276/277 change rarely and with notice, which is one reason we use them before portals.

From the codes on the 835 remittance: the group code, the claim adjustment reason code (CARC) and any remittance advice remark codes (RARC). We map those codes to categories your team agrees, such as eligibility, authorization, coding or timely filing. Staff can recategorize a claim, and every change is logged.

No. It drafts the packet: claim details, the remittance lines, supporting notes and your letter template. A staff member reviews, edits and signs it off before anything is submitted, and that sign-off is recorded. Which denials are worth appealing, correcting or writing off remains your team's decision.

No. It removes status lookups, re-keying of remittance codes and the manual sorting of open claims. Your staff still handle the exceptions: deciding whether to correct, resubmit or appeal, calling payers when a claim is stuck, and applying billing judgement. They start each day from a sorted queue instead of an aging report.

Not as part of this build, and we make no prediction claims. Consistently categorized denial history is the groundwork: once remittances are coded the same way over time, that data can feed a prediction model later. Our article on denial prediction architecture, linked on this page, describes that pattern.

Yes. We sign a Business Associate Agreement (BAA) before any PHI access: no one on our team sees protected health information until it is executed. We can sign your organization's BAA or provide ours. The software is built to HIPAA requirements (encryption, audit logging, role-based access), and it still belongs in your own HIPAA risk analysis.

Cost depends on scope, so we don't quote a generic range. Book a free 30-minute consultation: we review your requirements and workflow, then send a written scope and quote tied to what you actually need. Scope depends mostly on how many payers are included, which status route each offers, and how detailed your appeal packets need to be.