Platform / How BillCycle Works
How BillCycle works
What happens to a charge after your provider signs the note
BillCycle picks up the charge from your EHR, checks it, sends it, follows it and posts the payment. Your team steps in where judgment is needed, not for retyping and lookups.
- Charges flow in from your EHR
- Every claim checked before it goes out
- Work queues show what to do next
Charge to cash
Five steps, one connected record
Each claim keeps a single history from import to payment, so anyone on your team can see where it stands and what happened.
01
Import the charge
When a visit is coded in your EHR, the charge, patient details and insurance data arrive in BillCycle automatically through an API, HL7 or file feed.
02
Check the claim
BillCycle scrubs the claim against coding rules and payer requirements. AI estimates denial risk and shows the likely reason and the fix.
03
Submit and track
Clean claims go out electronically. Status updates come back into BillCycle, so your team sees rejections and delays without checking portals.
04
Work denials and AR
Denials are sorted by root cause and appeals are drafted for review. Open balances are ranked by value and timely filing risk.
05
Post payments and bill patients
ERAs post automatically, underpayments are flagged, and remaining patient balances go out on clear statements with online payment.
Before submission
Catch the problem before the payer does
Most denials come from errors that could have been caught at the front end: a missing modifier, a mismatched diagnosis, an inactive policy on file. BillCycle checks for these on every claim, not a sample.
Rule checks
Codes, modifiers, units and payer-specific edits are checked automatically.
AI risk check
Claims that look like past denials are flagged with the likely reason and a suggested fix.
Fix in one place
Your biller corrects the claim in BillCycle, or sends it back to the coder with a note.
| CPT | Mod | ICD-10 | Units | Charge |
|---|---|---|---|---|
| 99214 | missing | E11.9 | 1 | $165.00 |
| 93000 | I10 | 1 | $48.00 | |
| 36415 | E11.9 | 1 | $12.00 |
After submission
Every open claim has an owner and a next step
BillCycle builds work queues from claim status, denial reason and dollar value. Your team opens the queue and works from the top instead of building lists in spreadsheets.
Denials by root cause
Eligibility, authorization, coding and timely filing denials each go to the right person.
Appeals drafted
BillCycle prepares the appeal letter with claim details filled in. Your biller reviews, edits and sends.
Deadlines in view
Claims close to the timely filing limit move up the queue before they are lost.
| Claim | Payer | Status | Age | Amount | Next |
|---|---|---|---|---|---|
| #48213 | BCBS PPO | Rejected | 2d | $225 | Fix modifier |
| #48207 | Aetna | No response | 84d | $3,615 | Call payer |
| #48190 | Medicare | In process | 12d | $860 | Wait |
| #48172 | UHC | Denied CO-16 | 21d | $1,140 | Add info |
| #48165 | Cigna | Paid | 18d | $410 | Done |
Getting paid
Post payments and spot short pays automatically
ERAs match to claims and post without manual entry. When a payer pays less than your contracted rate, BillCycle flags the line so your team can follow up instead of writing it off.
Auto-posting
Payments, adjustments and patient responsibility post from the ERA.
Underpayment flags
Each payment is compared to the contracted rate you load for that payer.
Patient statements
Remaining balances move to patient billing, with online payment built in.
| CPT | Billed | Contracted | Paid | Status |
|---|---|---|---|---|
| 99214 | $165.00 | $112.40 | $112.40 | Matched |
| 93000 | $48.00 | $21.80 | $21.80 | Matched |
| 20610 | $210.00 | $86.20 | $44.00 | Underpaid $42.20 |
| 36415 | $12.00 | $0.00 | $0.00 | Denied CO-97 |
Who does what
What BillCycle does and what your team does
The system takes the repetitive work. People keep the decisions.
BillCycle does
Imports charges, runs claim checks, submits claims, tracks status, sorts denials, drafts appeals, posts ERAs and sends statements.
Your billers do
Review flagged claims, approve fixes, edit and send appeals, follow up on underpayments and talk to payers when needed.
Your managers do
Watch denial trends, AR aging and team workload in reports, and set the rules and priorities the queues follow.
Getting started
Go live without stopping your cash flow
We connect BillCycle to your EHR, load your payers and fee schedules, and run it alongside your current process until you are ready to switch. Typical go-live is [X] weeks.
Connect and test
We set up the EHR feed and test it with your real charges.
Load your rules
Payers, contracted rates, fee schedules and user roles are set up before go-live.
Train your team
Your billers learn the work queues on their own claims, not demo data.
FAQ
Questions about the workflow
Do our coders or providers need to change anything?
No. Providers chart and coders code in your EHR as they do now. BillCycle picks up the charge once it is ready to bill.
How often do charges come over from the EHR?
It depends on the connection. API and HL7 feeds can send charges as they are finalized. File feeds run on a schedule you set, such as [X] times a day.
What happens to claims already in process when we switch?
Open claims can stay in your old system until they are paid, or we can bring open AR into BillCycle. We agree on the plan during onboarding.
Can we set our own work queue rules?
Yes. Managers can assign queues by payer, denial type, provider, location or dollar amount, and change them as your team changes.
Who sends appeals and statements?
Your team does. BillCycle prepares them, but a person reviews and approves before anything goes to a payer or a patient.
Watch your own claims move through BillCycle
In a demo, we walk through each step using examples like the claims and denials your team sees every week.