Medical Billing & Claims Tracking

Track claims from submission to payment — denials, payments, payers, and fee schedules with a full audit trail.

Get claims paid faster — specialists work a denials worklist instead of a spreadsheet, managers watch collections and claim status roll up in real time, and your provider clients check their own claims in a portal instead of calling you. Every touch is audit-logged.

Built for billing teams that live in the gap between "submitted" and "paid" — and for the provider clients who keep calling to ask which is which.

Your billing specialists can

• Open a denials worklist and know exactly what to work next
• Follow a claim from submission through every status change to payment
• Post payments against claims and watch balances resolve

Your billing managers can

• See claims and collections across the whole book from one dashboard
• Manage payers, procedures, and fee schedules so claim amounts and denials resolve correctly
• Trace any claim's full history — every touch is audit-logged

Your provider clients can

• Log in to a portal and see their own claims and statuses — and only theirs
• Stop calling for updates, because the answer is on their screen

While your team works

Denial follow-ups and status notifications send automatically, and audit logging captures the trail — so nothing depends on someone remembering.

Role-based row-level security cleanly separates Admin, Billing Manager, Billing Specialist, and Provider Client.

What's included

• 5 user roles: Admin, Billing Manager, Billing Specialist, Provider Client, Public
• 14 data tables: Claims, Submissions, Denials, Payments, Payers, Procedures, Fee Schedules, Clients
• 18 workflows: Denial intake, appeal-deadline escalation, filing-deadline warnings, weekly A/R digest
• 8 email templates: Rejection, denial and deadline alerts, weekly A/R digest, monthly client summary
• 4 AI agents: Denial triage & appeal drafter, claim readiness checker, A/R worklist prioritizer, client Q&A
• Sample data: Demo users for every role + seeded claims, payments and payers — optional at install
• Security: Row-level security separates staff and provider clients

Data tables (14)

• Staff — Your billing team roster: each specialist and manager linked to their login, so claims, clients, activities and documents can be assigned to a named person and worklists stay personal.
• Clients — The provider practices you bill for, each with an assigned specialist and a portal login so they can check their own claims instead of calling you.
• Payers — The insurers you bill, including each payer's timely-filing and appeal windows that drive every deadline in the system.
• Denial Codes — Lookup of the CARC denial reason codes a payer can return, grouped by category, so every logged denial is classified consistently and the worklist can be sorted by cause.
• Fee Schedules — Each client's contracted rate per procedure code, used to auto-fill charges on claim lines so amounts are right the first time and underpayments stand out against the expected fee.
• Claims — The heart of the app: every claim you bill, with its payer, assigned specialist, status, balance and the timely-filing and appeal deadlines that decide whether the money is still recoverable.
• Procedures — The billed procedures on each claim, with charges auto-filled from the client's fee schedule so claim amounts are right the first time.
• Submissions — Each attempt to send a claim to a payer, so you can see when it went out, whether it was accepted or rejected, and what needs resubmitting.
• Denials — The denials worklist: every denied claim with its CARC code, category, appeal status and appeal deadline, so specialists always know what to work next.
• Payments — Payments and adjustments posted against claims, so balances resolve and managers can watch collections in real time.
• Activities — The follow-up log: every call, note and payer contact a specialist makes on a claim or client, with the next follow-up date that keeps the claim from going quiet.
• Documents — Medical records, authorizations, EOBs and appeal letters attached to a claim or client, uploaded by staff or by the provider through the portal to unblock a submission or appeal.
• Audit Log — Append-only record of who created or changed a claim and when, written automatically by the app for compliance review and never edited by hand.
• Inquiries — New-client inquiries submitted through your public website form, held with contact details and a status so managers can follow up with prospective practices.

User roles (5)

• Admin — Sets up payers, denial codes, fee schedules, staff and clients, reviews the audit trail, and is the only role that can delete.
• Billing Manager — Sees claims and collections across the whole book, reassigns work between specialists, and receives deadline escalations and the weekly A/R digest.
• Billing Specialist — Works their assigned clients' claims day to day: creates and submits claims, follows up, appeals denials and posts payments.
• Provider Client — A practice's back-office user who logs in to see only their own claims, payments and A/R, and uploads documents you are waiting on.
• Public — Visitors who submit the new-client inquiry form on your website, with no login and no access to any data.

Workflows (18)

• W1 Claim create — Numbers each new claim, assigns it to the client's specialist and calculates the timely-filing deadline from the payer's rules so the clock is visible from day one.
• W2 Claim payer or date-of-service change — When a claim's payer or date of service changes, recalculates the timely-filing deadline from the new payer's rules so the filing clock stays accurate.
• W3 Procedure create — When a procedure line is added to a claim, inherits the claim's client and specialist and fills in the charge from the client's fee schedule automatically.
• W4 Submission create — When a claim is sent to a payer, marks the claim as in flight and stamps the first submission date so timely-filing status is tracked from the moment it goes out.
• W5 Rejection handling — When a submission comes back rejected, flags the claim and emails the specialist with the filing deadline so it gets corrected and resent in time.
• W6 Denial intake — When a denial is logged, calculates the appeal deadline from the payer's window, marks the claim denied and alerts the specialist so the appeal clock never runs silently.
• W7 Payment posting — Applies each posted payment to its claim, updates the balance and closes claims out as they are paid in full.
• W8 Activity logged — When a specialist logs a call or note, stamps the author, records the claim as touched and moves its next follow-up date forward so the worklist reflects the latest action.
• W9 Document upload — When a provider uploads a record or authorization through the portal, links it to the claim and tells the specialist it may unblock a submission or appeal.
• W10 Claim reassignment propagation — When a claim is reassigned to a different specialist, re-keys all of its procedures, submissions, denials, payments, activities and documents so the new owner sees everything.
• W11 Client reassignment propagation — When a client is moved to a new specialist, reassigns all of that client's open claims, which in turn cascades to every related record.
• W12 Daily aging and follow-up refresh — Every day, re-ages every open claim into its A/R bucket and flags the claims whose follow-up date has arrived so the worklist is always current.
• W13 Appeal-deadline escalation — Every day, finds denials whose appeal window is about to close without an appeal filed and emails both the specialist and the managers, so a missed deadline takes two people to fail.
• W14 Filing-deadline warning — Every day, warns the specialist about claims that still have not been accepted as their timely-filing deadline approaches, before the revenue becomes unrecoverable.
• W15 Weekly aging digest — Every week, emails managers an A/R digest by aging bucket and payer, with the oldest balances and open denials, so they know where to push.
• W16 Monthly client summary — Every month, sends each provider practice a summary of charges, payments, adjustments, A/R and denials with a link to their portal.
• W17 Audit - claim record events — Every time a claim is created or edited, appends a row to the Audit Log recording who made the change and when, giving managers a full history of every claim.
• W18 Inquiry intake — Routes each new-client inquiry from your website form straight to the billing managers so prospective practices get a fast reply.

Email templates (8)

• T1 Claim Rejected
• T2 Denial Logged
• T3 Appeal Deadline Escalation
• T4 Filing Deadline Warning
• T5 Weekly Aging Digest
• T6 Monthly Client Summary
• T7 Portal Document Uploaded
• T8 New Client Inquiry

AI agents (4)

• A1 Denial Triage and Appeal Drafter — Reads a denial, works out whether it needs a corrected resubmission or a true appeal, and drafts the appeal letter for the specialist to review.
• A2 Claim Readiness Checker — Runs a pre-submission checklist on a claim and lists what is missing or inconsistent before it goes to the payer.
• A3 A/R Worklist Prioritizer — Picks the ten claims a specialist should work today, ranked by deadline risk and balance, and explains why each made the list.
• A4 Client Question Answerer — Answers a provider practice's questions about their own claims and payments in plain language, using only the records they are allowed to see.

Categories: Healthcare, Billing & Payments