U
USMON ProInsurance Billing
🔒 Demo device - a real biller can't switch to Supervisor (click still works here)
View
Sample, Dana · Biller SD

Your claims to reviewTeam claims - all billers

Each claim was preloaded by your techs and the reading neurologist - about 95% is already filled in. Open one and confirm it's right. We'll walk you through it step by step.

Every biller's queue in one place. Claims are tagged with who's working them, flagged for review, and held for your sign-off where required. Toggle to Biller to see the calm, single-queue view your team works in.

Team oversight

Supervisor viewSupervisor view - billers don't see this.
96
Claims worked today (team)
4:21
Avg time / claim
78%
Team active time
1
Dead-time flag
BillerClaims todayAvg time/claimActive %Claims/hrDead time
Sample, Dana343:12 91%8.4 Low
Demo, Alex293:48 88%7.1 Low
Mockdata, Sam214:40 79%5.6 Moderate
Example, Priya129:26 54%2.9 ⚑ High
⏱ 2 waiting6 waiting · sorted by filing deadline
⚑ Needs your review (2)
Testcase, Alice
PID 100001 · Claim 1000001 · DOS 10/20/2025
United Healthcare
◆ Out-of-network
$48,087.92
👤 Sample, DanaStart here✦ AI fields to confirmOpen →
Mockdata, Ray
PID 100002 · Claim 1000007 · DOS 10/18/2025
Aetna
◆ Out-of-network
$53,905.00
👤 Demo, Alex✓ All clearOpen →
Sample, David
PID 100004 · Claim 1000002 · DOS 10/20/2025
Humana
◆ Out-of-network
$61,240.00
👤 Sample, Dana $ high-value ⏳ Held for supervisor sign-off ⚑ Supervisor sign-off required Open →
Demo, Charles
PID 100005 · Claim 1000003 · DOS 10/14/2025
BCBS
◆ Out-of-network
$52,030.00
👤 Example, Priya✓ All clearOpen →
Testcase, Bruce
PID 100009 · Claim 1000009 · DOS 10/09/2025
Cigna
◆ Out-of-network
$41,880.00
👤 Demo, Alex⚑ Needs reviewOpen →
Example, Marta
PID 100006 · Claim 1000004 · DOS 06/18/2025
Mercy Care AZ
● Government in-network
$30,695.01
👤 Example, Priya✓ All clearOpen →
Reviewing Testcase, Alice · Claim 1000001 · United Healthcare ◆ OON ▦ Billing entity: Demo Neurophysiology LLC
Supervisor oversightWorked by Sample, Dana · ⏱ 4:12 on this claim · 1 AI override
1
Pull
2
Verify patient & insurance
3
Coding & diagnosis
4
Review
5
File
Step 1 of 5 · Pull

Here's the case we pulled

Everything below came straight from case #1000001 - your techs entered the demographics and insurance, and the reading neurologist's report set the coding. Take a look and confirm it's the right case.

Pulled from case #1000001 · 95% preloaded
Testcase, Alice
100001
1000001
10/20/2025
Professional + Technical
United Healthcare
Out-of-network
Anterior cervical discectomy & fusion, C5–C7
$48,087.92
Out-of-network - recovery continues at IDR downstream (No Surprises Act)
Filing deadline: 5 days - on track
✦ 6 events logged to audit trail
Step 2 of 5 · Verify patient & insurance

Confirm the patient and coverage

Here's what came from the case - confirm it's right, or fix anything that's off. One benefits item was flagged by AI for a quick check before you continue.

✦AI fields to confirm: 1 (this stage)
Patient
Testcase, Alice
Female
08/29/1971
1200 Sample Ridge Ln, Springfield, ST
555 555 0142
•••-••-4407
Inpatient
Self
Insurance & benefits
Commercial
United Healthcare
2W76y49mp67
Out-of-network

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
✦ 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.
Why out-of-network is expected here: charges are set above QPA by design. The remittance will come in low - the real recovery happens later via NSA negotiation and IDR. You don't need to do anything about that now; the clocks are tracked for you.
✦ 6 events logged to audit trail
Step 3 of 5 · Coding & diagnosis

Coding from the reading report

The service lines and diagnoses came from the reading neurologist's report. A few AI-suggested fields need your confirmation before we move on - everything else is already set.

✦AI fields to confirm: 3 (this stage)
Diagnoses (ICD-10) M50.120M54.12G89.18
✦ 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 so the service-line Dx pointers resolve correctly.
Service lines
#CPTModsUnitsDxChargeRendering (24J)Description
195887261A$361.25 Set provider →Needle EMG, non-extremity
295909261A$849.15Sample, Alan MDNerve conduction, 7–8 studies
395937264A B$6,332.50Sample, Alan MDNeuromuscular junction test
495938266A B$11,900.01Sample, Alan MDSSEP upper & lower
595939263A$17,850.01Sample, Alan MDMEP upper & lower
695955261A$10,795.00Sample, Alan MDEEG during surgery
✦ 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.
✦ AIAI-matched from report signature · via USMON MCP
Sample, Alan 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 out-of-network fee schedule (≈6× QPA). Units derived from 268 min of monitoring on file. Charged $48,087.92 total.
✦ 6 events logged to audit trail
Step 4 of 5 · Review

One last look

Everything's confirmed. Here's the whole claim in one place - if it all checks out, continue to file.

Testcase, Alice · PID 100001
1000001
United Healthcare · OON
-
6 lines
$48,087.92
Demo Neurophysiology LLC · NPI 1000000017
Sample Specialists Hospital, Springfield ST
Confirmed
✓
Case pulledFrom case #1000001 · 95% preloaded
✓
Patient & insurance verifiedOON benefits active · QPA ~$7,697 · timely filing 90 days
✓
Coding & diagnosisPrincipal Dx, derived units, and rendering provider all confirmed
Out-of-network - after filing, recovery continues at IDR downstream
Filing deadline: 5 days - on track
✦ 6 events logged to audit trail
Step 5 of 5 · File

Ready to file

This claim is complete and validated. Filing submits an 837P batch to the clearinghouse and moves the claim into Ongoing follow-up.

Testcase, Alice · 1000001
$48,087.92
Commercial OON → IDR
All checks pass automatically: NPI, charges, Dx pointers, place of service, ICD-10, and signature are valid. Nothing else needs your attention.
✦ 6 events logged to audit trail

Ongoing - Claim Follow-Up

Ongoing follow-up

Filed claims being worked: payments, out-of-network underpayments, and arbitration handed off to Arbitration. Wired end-to-end in the full router build - out of scope for this Guided Flow demo.

Folders

Folders

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

Reports

Reports

Recovery by channel, IDR win rate, aged-A/R, and clock-exposure trend. Out of scope for this demo build.

Manage

Manage

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

✓