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Billing / RCM first hour

By the end of this hour you will understand the billing work queue, submit your first claim, post an ERA payment, and know where denials live. Medipyxis does the coding prep; you audit and submit.

Before you start

• Your admin has added you with a biller role.
• Clearinghouse credentials are configured (Billing Operations → Clearinghouse Config).
• There's at least one signed visit sitting in the unbilled queue (create a test visit if not).

The billing loop in Medipyxis

Signed visit
    ↓
Unbilled queue  ← you audit, not build
    ↓
Submit to clearinghouse
    ↓
Clearinghouse response (accepted / rejected)
    ↓
Payer response (paid / denied / partial)
    ↓
ERA posting  →  denials routed to Denial Management

Step 1 — Tour the Work Queue (5 min)

1. Click Billing → Work Queue in the sidebar.
2. The Work Queue is a calendar-synced readiness board — one row per encounter — showing Visit Status, Note Status, Billing Readiness, and (once a claim exists) a Claim Status. Use the Ready / Pending Doc / Pending Sig presets and the filters to focus your day. See Work the Billing Work Queue.

Step 2 — Review and submit a claim (15 min)

1. Find an encounter that's Ready for Billing. Click Edit to open the claim form (/billing/new), or Review for the coding drawer.
2. On the claim form you see a CMS-1500 layout with: - Patient (from the patient record) - Payer (from insurance) - Diagnosis codes (ICD-10, from the visit note) - Procedure lines (CPT/HCPCS, auto-derived from documented procedures; drag to reorder) - Modifiers (25, 59, KX, etc. where appropriate)
3. Your job is to audit, not rebuild. Correct anything flagged.
4. Click Submit Claim when clean — it goes to the payer through Stedi.

Detail: Submit a claim

Step 3 — Review posted ERAs (10 min)

1. Open the ERA / Payments view (/era-eob).
2. ERAs (835) arrive automatically from Stedi over a webhook — there is no file to upload and no sync button. Matched lines auto-post and advance claims to Paid.
3. Reconcile any Unmatched lines by matching them to the correct claim. See ERA posting.

Step 4 — Work denials (10 min)

1. Open Denial Management. Denials are grouped by denial reason (CARC/RARC).
2. For each denial, Medipyxis shows the original claim, the rule evaluation from submission, and a suggested next action (corrected claim, appeal, write-off).
3. Take an action. Everything is timestamped and added to the claim's activity feed.

Detail: Denial Management

Step 5 — Find a claim fast (5 min)

• Press ⌘K / Ctrl+K from anywhere. Type a patient name, claim number, or visit date. Medipyxis ranks billing-related matches at the top when you're in the Billing workspace.

Result

• You've submitted at least one clean claim.
• You've posted at least one ERA line.
• You know where denials live and how to work them.

Next up

• Billing: Denial Management deep dive
• Work the Billing Work Queue
• Quick reference: biller daily