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Built for the way you bill.

Choose your kind of organization when you sign up, and G3 Flow starts your go-live plan and the claim checks your specialty needs: 10 rule packs and 36 rules, on top of the CMS edits every claim already gets. Turn any of them on, change how strict they are, or add your own.

Laboratories

Clinical and reference labs: requisitions in, medical necessity checked, and facility accounts billed alongside insurance.

Built into every lab claim

CLIALab NCDsCLFSMUENCCI

What G3 Flow checks

  • A CLIA number on every claim that needs one
  • Medical necessity against lab NCDs and coverage articles, by diagnosis
  • Test frequency limits and MUE unit limits
  • Prices from your charge master, and underpayments against the CLFS
  • Diagnostic lab coverage on the 271, with Medicare Advantage, QMB and BlueCard routing

Also for labs: requisitions read as evidence, corrections written back to the LIS after a person approves them, monthly invoices for client-bill accounts, and a CLIA step in your go-live plan.

Physician practices and clinics

From the front desk to the statement: coverage before the visit, clean E/M claims, and patients billed for exactly their share.

Starts with these packs

E/M modifiersTelehealthRadiology

What G3 Flow checks

  • An E/M on the day of a procedure needs modifier 25 or 57
  • A problem visit with a preventive visit needs modifier 25
  • Modifier 25 with no other service that day, or on a code that isn’t an E/M
  • Modifier 59 or X{EPSU} on an E/M code; an E/M billed with more than one unit; two office visits on one date
  • Telehealth place of service and modifiers by payer class
  • Professional (26) and technical (TC) components on imaging

Also for practices: pre-visit eligibility and estimates, check-in with copays and prior balances, prior authorizations, and underpayments against the physician fee schedule for your locality.

Hospitals and health systems

Institutional and professional claims together, with the UB-04 rules that trip up 837I files.

Starts with these packs

InstitutionalE/M modifiersRadiologyAnesthesiaTelehealth

What G3 Flow checks

  • Type of bill, and revenue codes paired with the right HCPCS
  • The original claim number on every replacement and void
  • Anesthesia time and units, pricing and physical status modifiers
  • Professional and technical components on imaging
  • Hospital editions of NCCI and MUE, when you turn them on

Also for hospitals: 837I in the same interchange as professional claims, and UB-04 forms for payers that still want paper.

Behavioral health and ABA

Units, credentials and authorizations, which is where behavioral claims are won or lost.

Starts with these packs

Behavioral health and ABAE/M modifiersTelehealth

What G3 Flow checks

  • ABA units per day, and who may render each code
  • Retired ABA Category III codes
  • A psychotherapy add-on without an E/M visit
  • Interactive complexity without a primary psychiatric service
  • A crisis psychotherapy add-on without the first hour

Also for behavioral health: prior authorizations with units and visits drawn down as claims go out, an alert at 80% used or 14 days left, and telehealth rules by payer.

Physical, occupational and speech therapy

Timed codes, discipline modifiers and visit limits, checked before the claim goes out.

Starts with these packs

TherapyTelehealth

What G3 Flow checks

  • The 8-minute rule: timed units against timed minutes
  • GP, GO or GN on every therapy code, for Medicare and for other payers
  • More than one discipline modifier on a line
  • A therapy evaluation billed with more than one unit

Also for therapy: authorizations with visit limits, alerts before they run out, and patient balances from each payer’s answer.

Medical equipment and supplies

Rentals, coverage modifiers and the DMEPOS fee schedule.

Starts with this pack

Durable medical equipment

What G3 Flow checks

  • Capped rental month modifiers (RR with KH, KI or KJ) and the 13-month limit
  • PAP devices and supplies without KX, GA or GZ for Medicare
  • KX together with GA or GZ

Also for equipment suppliers: underpayments against the DMEPOS fee schedule, and DME editions of MUE when you turn them on.

More specialty checks, for anyone who needs them.

Turn on any pack for any client, whatever kind of organization you are.

G3 Flow’s specialty rule packs for a hospital customer: anesthesia, E/M and institutional claims on, ambulance, behavioral health, dental and medical equipment off. G3 Flow’s specialty rule packs for a hospital customer: anesthesia, E/M and institutional claims on, ambulance, behavioral health, dental and medical equipment off.
One switch per pack, per clientEach client starts with the packs for its kind of organization. Turn any pack on or off, open it to turn single rules off or change how strict they are, and see who changed what.

Anesthesia

Six rules for time, units and modifiers.

  • Anesthesia time and units
  • A pricing modifier on every line, for Medicare and other payers
  • No more than one pricing modifier on a line
  • A physical status modifier
  • Qualifying circumstance codes billed to Medicare

Radiology

Professional and technical components.

  • 26 for the physician on hospital patients, never TC
  • Global and component billing that don’t overlap

Ambulance

Two rules for every transport.

  • Origin and destination modifiers, with mileage paired to the transport, to a tenth of a mile
  • The point-of-pickup ZIP code for Medicare

Telehealth

Four rules by payer class.

  • Place of service 02 or 10 with the right modifier
  • 95 and 93 on the same line
  • GT on a Medicare professional claim
  • A hands-on procedure billed as telehealth

Dental

CDT procedures with what they require.

  • Tooth numbers, surfaces and quadrants, with surface counts that match the code, and codes limited to anterior, posterior, premolar or molar teeth

Your own rules

Written in Automation Studio, tested on past claims, and approved by a second admin before they run.

  • Every rule hit is logged, so you can see which ones prevent denials

Every claim also gets the CMS edits: NCCI procedure-to-procedure pairs, MUE unit limits, LCD and NCD medical necessity, code validity for the date of service, prior authorization, and your charge master. See how claims work

Tell us your specialty. We’ll set up the rest.

Your organization type sets your go-live plan and your starting rule packs, and you can change both later.

Talk to us See pricing