Billing & Insurance Module
Billing operations including insurance verification, payer management, and revenue cycle overview.
3
Pages
3
API Endpoints
7
High-Priority Orgs
4
Requirements
Organization Relevance
MSO: High TPA: High MCO: High Health Plan: High FQHC: High IPA: High PHO: High ACO: Medium
How It Works
The billing module coordinates insurance verification before services, manages payer relationships, and provides a revenue cycle overview. Real-time eligibility checks prevent claim denials. Payer profiles maintain contact information, submission requirements, and fee schedule associations.
Requirements
- Real-time eligibility verification (X12 270/271)
- Payer profile management
- Revenue cycle reporting
- Payment posting integration
Target Audience
Billing Staff, Revenue Cycle Managers, Front Desk Staff
Pages (3)
| Page | Purpose | Key Features |
|---|---|---|
| Billing Overview | Revenue cycle dashboard with key billing metrics and performance indicators | Revenue metrics, Aging analysis, Collection rates, Denial trends |
| Insurance Companies | Manage insurance company profiles and submission requirements | Payer directory, Contact management, Submission rules, Fee schedule links |
| Insurance Verification | Real-time insurance eligibility verification and benefit inquiry | Eligibility check, Benefit display, Coverage details, Verification history |
API Integrations
X12 270/271 Eligibility APIPayer profile APIRevenue cycle dashboard API
Referenced Resources
X12 270/271 Implementation GuideCAQH CORE Operating RulesAMA CPT Manual
Expected Results
Reduced claim denials through proactive eligibility verification, accurate payer information, and revenue cycle visibility.