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Insurance and billing

Eligibility, claim scrubbing, and denial triage in one workspace.

Signed encounters with ICD-10 codes auto-create claims, eligibility runs before booking, and denials show the next action.

Six tabs, end to end

Six tabs: claims, eligibility, reports, enrollment, ledger.

Each tab is a different job against the same patient and payer data.

WorkspaceBilling / Overview
Total billed
$248.6k
+8.2%vs last 30 days
Total collected
$214.9k
+11.4%vs last 30 days
Outstanding
$33.7k
-4.1%vs last 30 days
Denied
$6.2k
-2.7%vs last 30 days
Status distribution412 claims, last 30 days
  • Paid 62%
  • Submitted 17%
  • Pending 9%
  • Partial 7%
  • Denied 5%
Collection trend12 weeks, $k collected
$67.0k+24% over the quarter

Live workspace uses your patient and payer data. Per-claim actions on every row: view detail, resubmit, appeal, mark as paid.

Claim status flow

From signed encounter to paid claim, with denials handled in line.

Claims generate from signed encounters that have ICD-10 codes.

  1. Pending
  2. Submitted
  3. Accepted
  4. Paid
  1. Denied
  2. Appeal
  3. Resubmit
  4. Paid

Partially paid is its own status. Remaining balance tracks against the original line items, so the patient ledger and the claim agree.

Insurance coding

Workspace-wide defaults for how AriaMD suggests codes.

Settings, Tools and AI, Insurance Coding carries three controls:

  • Default ICD-10 code sets for the diagnoses the practice uses.
  • A confidence threshold for how many code candidates appear.
  • Specialty-specific rules that add or restrict codes.
Eligibility before you book

Real-time verification at scheduling, intake, and on demand.

The response includes the values that decide whether a patient can be seen next week or needs to wait on prior auth.

Running eligibility S.R., Aetna Behavioral Health
Patient S.R.
Member W••••3284, group 0042
Aetna Behavioral Health
PPO Behavioral Health
Active
  1. CoverageActive
  2. Deductible$750 of $2,500 met
  3. Copay$30 per visit
  4. Out-of-pocket max$4,200 left
  5. Covered services90791, 90834, 99213, J0177
Verified in 1.2 s270101 X12 EDI 270/271
Credentialing and enrollment

Provider and payer participation, one row per payer.

Active, pending, and not enrolled decide whether a claim can ship today. Effective dates and credentialing contacts live on the row.

Provider NPI
1659••3214
Pulled from Settings, Clinic.
Payer
Aetna Behavioral Health
Network and panel scope per row.
Enrollment status
Active
Active, pending, or not enrolled.
Effective date
2025-08-14
Drives claim eligibility windows.
Service locations

Assigned per encounter. Drives location-based coding rules.

The assignment sets place of service and which payer rules apply. Telehealth and in-office bills do not look the same on the wire.

Service Location Assigned is also an automation event. You can run a custom AriaMD prompt when a location lands on an encounter: billing checks, location-specific compliance, or routing into the right ledger view.

See built-in telehealth See automations and event triggers
See it on a real claim

Twenty minutes: sign a sample encounter, follow the claim, run eligibility.

From signed note to paid claim, denial path included, in the same workspace clinicians already use.

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Live in 2 weeks or less BAA signed by default

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