Help / Modules / Billing

Billing Operations overview

The Billing Operations module is the central surface for managing the full revenue cycle — from claim creation through payment reconciliation — within Medipyxis.

Module layout

Navigate to /facility/{facility_uuid}/billing. The module opens on four tabs:

Tab	What it shows
Overview	High-level KPIs: total billed, pending claims, denial rate, and recent payment activity for the current period.
Claims	All claims in the facility, searchable and filterable by status, payer, date of service, and rendering provider.
Denials	Claims that have been denied, along with their denial appeal status and next action.
Payments (ERA)	Electronic Remittance Advice records received from the clearinghouse, matched against posted claims.

The Billing Operations landing page. The Overview tab is active by default.

Clearinghouse integration

Medipyxis connects to Stedi as the clearinghouse for electronic claim submission (837P), eligibility checks (270/271), claim status (276/277), and remittance advice (835). Claims that reach Exported status are sent to Stedi automatically; status updates flow back into the Work Queue and the Payments (ERA) tab in real time, without polling. Stedi replaced ClaimMD in May 2026 — historical ClaimMD claims remain visible for reference, but all new submissions go through Stedi.

Your providers must be enrolled with each payer through Stedi before claims can flow. See Set up billing and the Stedi clearinghouse. Contact your practice administrator if claims are not advancing past Exported.

Claim status lifecycle

Every claim moves through a defined sequence of statuses. Understanding this lifecycle helps you prioritize work and identify bottlenecks.

Status	Meaning
Draft	Claim started but not yet complete.
Pending	Auto-created from a completed visit, awaiting biller review.
Needs Info	A required field is missing or a validation error must be resolved before the claim can advance.
Approved	A biller reviewed the claim and marked it ready for export.
Exported	The claim has been exported / sent to Stedi.
Submitted	Marked as submitted to the clearinghouse.
Paid	The payer adjudicated the claim and an ERA has been received and posted.
Denied	The payer denied the claim — it enters the Denials workflow.
Appealed	An appeal has been filed on a denied claim.
Cancelled	Claim voided / cancelled.

Separately from this system lifecycle, billers set a Claim Status on each claim in the Work Queue (Ready, Hold, Billed, Paid, Denied, Appealed, Write-Off, and more). That manual status is the biller's working state and is what most of the queue's filters and bulk actions operate on.

CMS requires that claims for Medicare beneficiaries be submitted within one year of the date of service. Claims that remain in Pending or Needs Info beyond your organization's internal filing deadline will be flagged in the AR Aging report.

A claim can enter the Denials workflow at any point after submission if the payer returns a denial. The claim moves to Denied (and to Appealed if you file an appeal), while the denial's own appeal status tracks separately — see Denial Management.

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