New Insurance Billing

The worklist you know - same columns, same billing-type tags, same aging & IDR view. Cases are preloaded by your techs and reading neurologists; your job is to review, fix the exceptions, and file.

28 needs review 12 ready to file 3 waiting on info 4 aged > 90d Customize these on your home dashboard →

Supervisor oversight

Supervisor viewHidden from billers · same worklist underneath

Claims worked today (team)

4:21

Avg time / claim

78%

Team active time

Dead-time flag

Biller	Claims today	Avg time/claim	Active %	Claims/hr	Dead time
Sample, Dana	34	3:12	91%	8.4	Low
Demo, Alex	29	3:48	88%	7.1	Low
Mockdata, Sam	21	4:40	79%	5.6	Moderate
Example, Priya	12	9:26	54%	2.9	⚑ High

Patient↕	Claim / DOS↕	Billing type	Payer	Charges↕	Days aged↓	IDR state	Status↕
Testcase, Alice PID 100001	1000001 10/20/2025	PRO + TECH	United Healthcare ◆ Out-of-network	$48,087.92	5d	Eligible (OON)	▲ Needs review	Open →
Sample, David PID 100004	1000002 10/20/2025	PRO + TECH	Humana ◆ Out-of-network	$61,240.00	5d	Eligible (OON)	▲ Needs review	Open →
Mockdata, Ray PID 100002	1000007 10/18/2025	PRO ONLY	Aetna ◆ Out-of-network	$53,905.00	7d	Eligible (OON)	✓ Ready to file	Open →
Demo, Charles PID 100005	1000003 10/14/2025	PRO ONLY	BCBS ◆ Out-of-network	$52,030.00	11d	Eligible (OON)	⏸ Waiting on tech	Open →
Testcase, Bruce PID 100009	1000009 10/09/2025	PRO + TECH	Cigna ◆ Out-of-network	$41,880.00	16d	Eligible (OON)	✓ Ready to file	Open →
Example, Marta PID 100006	1000004 06/18/2025	PRO + TECH	Mercy Care AZ Medicaid HMO · in-network	$30,695.01	127d	N/A (Gov)	✓ Ready to file	Open →
Specimen, Tom PID 100007	1000005 06/18/2025	TECH ONLY	Medicare Government	$34,290.00	129d	N/A (Gov)	▲ Needs review	Open →
Sample, Nora PID 100008	1000008 06/12/2025	TECH ONLY	Medicare Government	$29,140.00	135d	N/A (Gov)	✓ Ready to file	Open →

/Testcase, Alice

Testcase, Alice

PID 100001Claim 1000001 DOS 10/20/2025Billing Pro + Tech Payer United Healthcare◆ Out-of-network

▲ Review in progress

Park this claim - what are you waiting on?

Claim notes - synthetic

Tech confirmed policy # from payer portal; OON benefits active.Mockdata, Sam · 10/21/2025

Reading neurologist's report attached; principal Dx pending AI confirm.Sample, Dana · 10/21/2025

⏸Parked. · saved at your spot. Open another claim and come back anytime.

The whole claim on one page. 95% preloaded from case #1000001 - techs entered demographics & insurance, the reading neurologist's report set the coding. No separate tabs or popups to see patient info or the CMS-1500 - just scroll, review each section, and fix the 2 flagged exceptions.

Demographics

Box 2Box 3Box 5Box 6

Preloaded by tech

Patient name (Box 2)

Testcase, Alice

Sex (Box 3)

Female

DOB (Box 3)

08/29/1971

Address (Box 5)

1200 Sample Ridge Ln, Springfield, ST 00000

Phone (Box 5)

555 555 0142

SSN

•••-••-4407

EMR status

Inpatient

Relationship to insured (Box 6)

Self

Insurance & Benefits

Box 1Box 1aBox 4Box 11

Preloaded by tech · VOB 10/14/2025

Insurance type (Box 1)

Commercial

Payer

United Healthcare

Insured's ID (Box 1a)

2W76y49mp67

Network

Out-of-network

Insured's name (Box 4)

Testcase, Alice (Self)

Policy / group (Box 11)

GRP 88041 · UHC Choice Plus

Verification of benefits (VOB) status

✦ AIflagged by AI · via USMON MCP

⚠ Stale - last verified 10/14/2025 (VOB older than payer re-verify window at filing)

AI flag: benefits on file exceed United Healthcare's re-verification window for OON claims. Recommend re-checking eligibility & OON benefits before filing so the QPA on record is current.

In-network (not applicable)

Status: No in-net contract
Reason: OON by design

◆ Out-of-network - NSA applies

OON benefits: Active
QPA on file: ~$7,697
Timely filing: 90 days
NSA protection: Yes · IDR-eligible

Hospital / Facility

Box 17Box 18Box 32

Preloaded by tech

Service facility (Box 32)

Sample Specialists Hospital, Springfield ST

Facility NPI (Box 32a)

1000000032

Place of service

21 - Inpatient Hospital

Referring provider (Box 17)

A. Example, M.D.

Referring NPI (Box 17b)

1000000048

Admission (Box 18)

10/20/2025

Discharge (Box 18)

10/21/2025

Authorization on file

Prior auth #A-559120 · verified

Procedure & Diagnosis

Box 21Box 24B

From reading neurologist's report

Procedure monitored

Anterior cervical discectomy & fusion, C5–C7

Place of service (Box 24B)

21 - Inpatient Hospital

Principal diagnosis - ICD-10 (Box 21)

✦ AIAI-suggested principal code · via USMON MCP

M50.121 - Cervical disc disorder with radiculopathy, C6–C7

Extracted from the reading neurologist's report: "…moderate radiculopathy at the C6–C7 level with corresponding SSEP/MEP changes." Confidence 0.94. Placed first (pointer A) so the service-line Dx pointers resolve correctly.

Supporting diagnoses (prefilled)

M50.120 · M54.12 · G89.18

Coding & Service Lines

Box 24A–J

From reading neurologist's report

#	CPT (24D)	Mods	Units (24G)	Dx ptr (24E)	Charge (24F)	Rendering (24J)	Description
1	95887	26	1	A	$361.25	Demo, Eric MD	Needle EMG, non-extremity
2	95909	26	1	A	$849.15	Demo, Eric MD	Nerve conduction, 7–8 studies
3	95937	26	4	A B	$6,332.50	Demo, Eric MD	Neuromuscular junction test
4	95938	26	6	A B	$11,900.01	Demo, Eric MD	SSEP upper & lower
5	95939	26	3	A	$17,850.01	Demo, Eric MD	MEP upper & lower
6	95955	26	1	A	$10,795.00	Demo, Eric MD	EEG during surgery

Units - line 4 (95938, SSEP) (Box 24G)

✦ AIAI-derived from monitoring minutes · via USMON MCP

6 units

Derived from 268 minutes of intraoperative SSEP monitoring on the tech report (≈45 min/unit). AI proposed the unit count; confirm it matches the documented time.

Rendering provider - line 1 (95887) (Box 24J)

✦ AIAI-matched from report signature · via USMON MCP

Demo, Eric MD - NPI 1000000048

Line 1 had no rendering provider. AI matched the signing neurologist from the reading report against the NPI registry. Confidence 0.97.

OON pricing applied: charges set at the client's OON fee schedule (≈6× QPA). Charged $48,087.92 total.

Billing & Provider

Box 25Box 31Box 33

Preloaded

Billing provider (Box 33)

Demo Neurophysiology LLC

Billing NPI (Box 33a)

1000000017

Tax ID (Box 25)

12-3456789

Signature (Box 31)

On file - Demo, Eric MD

Rendering taxonomy (Box 24J)

2084N0400X

Accept assignment (Box 27)

Yes - assignment accepted

✦ AI fields to confirm

AI proposes, you decide - nothing files unconfirmed.

Claim validation Live

Replaces the old end-of-process "Information Required" popup. Updates as you work - no surprises at export.

Information required4 AI fields to confirm before this claim can file.

0 of 6 sections reviewed0%

✦ Highlighted AI fields 4

✦

Stale VOB flagInsurance & Benefits

→

✦

Principal ICD-10 (M50.121)Box 21 · Procedure & Dx

→

✦

Derived units - 95938Box 24G · Coding & Lines

→

✦

Matched rendering providerBox 24J · Coding & Lines

→

Review & approve 0/6

○

DemographicsBoxes 2, 3, 5, 6

○

Insurance & BenefitsConfirm AI field first

○

Hospital / FacilityBoxes 17, 18, 32

○

Procedure & DxConfirm AI field first

○

Coding & LinesConfirm 2 AI fields first

○

Billing & ProviderBoxes 25, 31, 33

Automatic checks ✓ 5

✓

Timely filing OKUHC · 90-day window · 5d used

✓

Billing NPI valid (Box 33a)Luhn & NPPES check passed

✓

Charges balance6 lines total $48,087.92

✓

Dx pointers & POS validPointers A–C · POS 21

✓

Signature on file (Box 31)Demo, Eric MD

Validated continuously - 7 events logged to audit trail.

Ongoing - Claim Follow-Up

Filed claims being worked: payments posting, out-of-network underpayment appeals, and IDR follow-up - the same follow-up worklist billers use today. Out of scope for this demo build.

Folders

Client & entity folders, saved batches, and archived claims. Out of scope for this demo build.

Reports

Aged-A/R, clean-claim rate, denial trends, and collections by payer. Out of scope for this demo build.

Manage

Payer rules, fee schedules, providers, and user permissions. Out of scope for this demo build.

	24F · Charges	Description
1		Needle EMG, non-extremity
2		Nerve conduction, 7–8 studies
3		Neuromuscular junction test
4		SSEP, upper & lower
5		MEP, upper & lower
6		EEG monitoring during surgery
Total charge (Box 28)	$48,087.92

New Insurance Billing

Supervisor oversight

Park this claim - what are you waiting on?

Claim notes - synthetic

Demographics

Insurance & Benefits

In-network (not applicable)

◆ Out-of-network - NSA applies

Hospital / Facility

Procedure & Diagnosis

Coding & Service Lines

Billing & Provider

Ongoing - Claim Follow-Up

Folders

Reports

Manage

Claim filed