Claims, prepared properly and answered in plain language.

What a claim goes through.

The provider records the visit with its codes. From that, LogBlues builds the claim in the form the payer expects:

• Office visits: 837P (the CMS-1500). Doctors, therapists, urgent care, med spas and every other professional service, with CPT, HCPCS and ICD-10-CM codes.
• Facilities: 837I (the UB-04). Dialysis, nursing and assisted living, home health, surgery and procedure centers, with the type of bill, revenue codes and the attending provider.
• Dental: 837D (the ADA claim). CDT codes with the tooth and surfaces on every line that needs them.

Before the visit, the front desk can check the patient’s coverage with the payer (270/271), and LogBlues shows whether the provider is in network with that payer on that day. After a claim is sent, the payer’s “we got it” and “accepted or rejected, and why” come back too (999 and 277CA).

Before it goes anywhere, a validator checks the things payers reject claims for: a missing referral, a diagnosis that does not support the procedure, an identifier in the wrong shape. Catching that here costs a minute. Catching it after a payer does costs a month.

When the payer answers.

Payers reply with an 835 remittance. LogBlues reads it, matches each line to the claim it belongs to, and shows what was paid, what was adjusted, and what was denied.

Denials arrive as numeric CARC codes. We translate them, so the person working the queue reads “the payer wants the referring provider on this claim” rather than “CO-16” and a trip to a lookup table.

When a claim is denied.

A denial that nobody works is money gone. So every denied line in the payer’s file becomes a task on the billing person’s list: the patient, the payer, the code, the reason in plain words, and the appeal deadline as the due date. It turns Critical two weeks before that date. Import the same file twice and nothing doubles.

Billing keeps a Denials section where each one stays until it is appealed, resolved or written off. One click drafts the appeal letter with the clinic, the patient, the claim and the payer’s reason filled in, ready for the provider’s note, and saves it to the patient’s files. Reports has a Denials report by payer, by reason, by code and by provider, so a reason that repeats gets fixed once.

Before a claim leaves, LogBlues checks it the way a payer’s computer will: a lone modifier 25 or 59, a line that repeats another, a visit older than ninety days, a missing member ID. What would bounce is held with the reason in words.

What it costs.

Every paid plan includes a small monthly allowance. After that allowance, each claim accepted for submission is $0.50.

Charged only when a claim is accepted for submission. Front-desk and administrative staff never count towards a plan.

Why 50¢ when some competitors charge 25¢ or less?

Because that is what the clearinghouse charges us. We pass the cost through without a markup. If your practice files a lot of claims, on Enterprise or a custom plan with more providers, there is room to negotiate a better rate, as long as the math still works for both sides: write to us at sales@logblues.com. And on the whole bill, once the assistant, the seats and the front desk are counted, LogBlues stays very competitive for a practice with several providers.

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Not billing payers yet? Credentialing, contracts, clearinghouse enrollment and your first paid claim — the whole path, in order, with the numbers to call.