Help for billers and rcm specialists
Claims, ERA posting, denials, eligibility, A/R, patient statements, underpayments and ERA enrollment.
You collect the money. Every claim moves through a cycle: charge entered → claim submitted → ERA posted → denial worked → patient billed → cash received → A/R cleared. Your job is to keep that pipeline flowing for every practice your agency manages.
Your day in 15 minutes
- Denial Inbox — overnight ERA-driven denials, auto-classified. Clear the AUTO-APPEALABLE bucket first.
- Claims tab → status=submitted — anything stuck >7 days, follow up.
- Payments tab — check for new ERA/EFT, post anything pending.
- A/R aging — anything new in 60+ days needs immediate attention.
- Statements tab — any new draft statements from last night's job, send the ones with email on file.
8 guides for billers and rcm specialists
Work the Denial Inbox start to finish
Every denial is acted on: auto-appealable ones have an appeal draft generated and queued for review; coding-fix ones are corrected and resubmitted…
Read the guidePost an ERA file
Every claim in the ERA has its payment recorded, allowed amount captured, adjustments split (contractual vs non-contractual), denials extracted (with…
Read the guideSubmit a claim and track it in Credentik
The claim is in Credentik with the right patient, provider, payer, DOS and CPT lines, it passed Check claim (or the credentialing gate was knowingly…
Read the guideVerify patient eligibility before a visit
You know definitively: was this patient covered by this plan on this date of service, what's their copay/deductible/coinsurance, is there a need for prior…
Read the guideWork A/R aging buckets
Every claim aged 60+ days has been touched in the past 14 days — called on, appealed, escalated, or written off with documentation. Nothing rots silently.
Read the guideSend a branded patient statement
The patient receives a tenant-branded email with line-item balance breakdown and an optional "Pay Online" CTA. Statement status flips draft → sent.
Read the guideDetect and recover an underpayment
The underpayment is either (a) recovered via appeal with the payer, (b) confirmed as your fee schedule being wrong, or (c) documented as an acceptable…
Read the guideEnroll a payer for ERA + EFT delivery
For each payer: - ERA files arrive automatically in your clearinghouse (usually Availity) or your SFTP drop instead of you logging into a portal.
Read the guideRun every client from one calm workspace
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