Notes on getting paid.

Eligibility runs before the patient arrives, and again when a charge is still missing coverage. Coverage discovery looks for a payer when the one on file is wrong or absent. Benefits come back in plain language, and the estimate the desk quotes is built from that response.

Payer routing follows the coverage that was found, including a secondary, so the claim is not aimed at the wrong plan. A prior authorization is tracked on the visit it belongs to, before the claim is built.

Charges can arrive in whatever format the source system sends. G3 Flow scrubs each claim against CMS edits and the specialty rule pack for that organization, and it flags denial risk before the file goes out. The 837 that leaves is the one that passed those checks.

After it is sent, acknowledgments come back as 999 and 277CA files, and the claim stays in one matrix with its status. A secondary claim waits on the primary’s remittance. Paper forms are there for the payers that still require them.

ERAs are collected and checked. Each adjustment is classified from the reason code on the remittance, and the deposit in the bank is matched to that remittance before anything posts. A payment posts once, into the billing system the organization already uses.

Recoupments, interest, and payments that arrive without an ERA are their own work. Paper EOBs are entered the same way an electronic remittance is. Month-end is the match between what the bank received and what was posted, and the cash forecast is built from the claims still open.

A denied line does not sit in a report waiting for someone to notice it. It becomes a piece of work, with the reason code, the claim, and an appeal draft. An underpayment is flagged against the expected allowed amount, so a short pay is visible next to a full denial.

Insurance accounts receivable are ranked, so the oldest and largest balances are the ones in front. Status inquiries and attachments go out from that same claim, and the history of what was asked and what came back stays on it.