Solutions / Claims Management
Claims management
Every claim tracked from submission to payment.
BillCycle builds and sends your electronic claims, reads every clearinghouse and payer response, and puts the claims that need attention in front of the right biller.
- 837P and 837I claims sent electronically
- Status updates from 999, 277CA and 276/277
- Secondary claims sent automatically after primary pays
| 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 |
The claim lifecycle
One path for every claim, with nothing falling through.
Each claim has a clear status and an owner at every stage, so nobody has to ask where a claim is.
01
Submit
Scrubbed claims are batched into 837 files and sent through your clearinghouse [clearinghouse options to confirm]. Paper CMS-1500 and UB-04 are available for payers that still require them.
02
Acknowledge
BillCycle reads the 999 and 277CA acknowledgments and marks each claim accepted or rejected at the front end.
03
Track
Claim status is checked with 276/277 inquiries on a schedule, so claims sitting with the payer show up before they go stale.
04
Close
When the ERA arrives, the claim is paid, denied or moved to secondary. Every step stays on the claim history.
Work queues
Your billers see their work, not the whole pile.
Claims are routed into queues by status, payer, provider, location or dollar value. Each biller opens BillCycle and sees exactly what needs action today, with the reason it is there.
Rejections first
Front-end rejections, like an invalid subscriber ID or missing NPI, land in a queue with the clearinghouse message in plain language.
No-response claims
Claims with no payer response after [X] days are flagged for follow-up, so they do not age quietly.
Assign and reassign
Managers can balance workloads by moving claims between billers in a couple of clicks.
| CPT | Mod | ICD-10 | Units | Charge |
|---|---|---|---|---|
| 99214 | missing | E11.9 | 1 | $165.00 |
| 93000 | I10 | 1 | $48.00 | |
| 36415 | E11.9 | 1 | $12.00 |
Secondary and tertiary claims
Secondary claims go out without someone remembering to send them.
When the primary payer’s ERA posts, BillCycle builds the secondary claim with the primary payment and adjustment data attached, and sends it to the next payer on file. Crossover claims from Medicare to Medigap or Medicaid are tracked so you can confirm they actually arrived.
COB data carried forward
Primary paid amounts, CARC adjustment codes and patient responsibility are included on the secondary 837.
Crossover tracking
If an automatic crossover claim does not show up at the secondary payer, BillCycle flags it so you can send it directly.
Patient balance held correctly
The patient is not billed until secondary and tertiary payers have finished, avoiding statements you later have to refund.
Built for daily billing work
The claim tasks your team handles every day.
Corrections, resubmissions and follow-up are handled inside BillCycle, with the full history kept on each claim.
- Corrected claims with frequency code 7
- Voided claims with frequency code 8
- Batch resubmission after a fix
- Timely filing deadline shown on every claim
- Proof of timely filing saved from acknowledgments
- Notes and follow-up dates on each claim
- Claim history with every status change
- Search by patient, payer, claim number or date of service
Why a dedicated billing system
Claim tools built for billers, not added on to charting.
Billing built into an EHR often stops at sending the claim. BillCycle is built around what happens after.
| Billing built into your EHR | BillCycle | |
|---|---|---|
| Rejection messages | Raw clearinghouse codes | Plain language with the fix |
| No-response follow-up | Manual reports | Automatic flags after [X] days |
| Secondary claims | Often sent by hand | Built and sent automatically |
| Timely filing | Tracked in spreadsheets | Deadline on every claim |
| Work routing | One shared list | Queues by biller, payer or value |
| Multi-client view | Not available | Built in for billing companies |
FAQ
Claims management questions
Do we need to change clearinghouses?
[Clearinghouse policy to confirm: state whether BillCycle works with the practice’s existing clearinghouse or uses a bundled one.]
Does BillCycle support institutional claims?
BillCycle sends professional claims (837P) and institutional claims (837I) [confirm 837I availability at launch].
How are front-end rejections handled?
BillCycle reads the 999 and 277CA responses, translates the rejection into plain language and routes the claim to a biller with the field that needs fixing.
How do you keep claims from missing timely filing limits?
Each payer’s filing limit is stored in BillCycle, and every claim shows days remaining. Claims approaching the limit are moved up the queue.
Can we still send paper claims?
Yes. For payers that require paper, BillCycle produces CMS-1500 and UB-04 forms from the same claim data.
See where your claims stand, all in one queue.
We will walk through your claim volume, payer mix and current follow-up process, then show you the same work in BillCycle.