Biller cheat sheet

reference ⏱ 2 min read Billing Updated 2026-07-08

Your daily loop: work the Work Queue → submit → post ERAs → work denials. Medipyxis does the coding prep; you're the safety net.

Claim Status glossary

The Work Queue's Claim Status dropdown (set by the biller) uses these values:

Status	Meaning
Needs Coding / Eligibility Needed	Not ready to submit yet
Ready	Reviewed and ready to submit
In Progress / Hold / Flag Clinical	Working it / paused / sent back to the clinician
Billed	Submitted to the payer
Paid / Partial Pay	Payment posted (fully / partially)
Denied	Payer denied; work it in Denial Management
Appealed / Corrected	Appeal filed / claim corrected and resubmitted
Patient Responsibility / Write-Off / Void	Closed outcomes

Code type	Comes from
ICD-10	Wound Assessment + History of Present Illness
CPT/HCPCS	Procedures & Supplies + graft UIN applied
Modifiers	Rule engine: LT/RT from wound location, 25 from E/M + procedure same day, 59 when bundling conflict
Place of service	Facility default, overridden by visit location
Units	Graft size in cm² (auto-calculated from L × W measurements)

Task	Shortcut
Jump to a claim	`⌘K` + claim number
Copy a fixed claim for resubmit	Claim detail → `⌘D`
Open ERA quickly	`G` then `E`
Add a note to a claim	`N` on claim detail

CARC / RARC	Likely root cause	Fix
CO-50 (not medically necessary)	Missing LCD element	Add an addendum to the visit note that resolves the LCD item
CO-197 (precert missing)	No auth on file	Obtain retro-auth; if denied, appeal with clinical docs
CO-16 (missing information)	Modifier or ID missing	Correct on the claim form (`/billing/new`) and resubmit
CO-29 (past timely filing)	Late submission	Check root cause; appeal only if system error
PR-45 (charge exceeds allowed)	Charge out of date	Update the facility Charge Master

Each claim and denial keeps a full activity trail. When appealing, reference the claim number, DOS, and denial CARC — see Denial Management.

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