Clovai Billing™

Revenue Cycle Eligibility · Prior auth · Scrubbing ···

The visit is documented. The claim goes out clean. The money shows up.

The full revenue cycle in one place: eligibility at booking, prior authorization tracked to expiration, charges captured from the signed note, claims scrubbed against NCCI and payer edits before submission, ERAs auto-posted, and denials worked by root cause instead of by pile.

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Re-keying from chart to claim

837P/I

Direct or through your clearinghouse

835

Remittances posted automatically

NCCI

Edits applied before submission

Per payer

Timely-filing countdown

Root cause

Denial worklists, not a pile

Front of the cycle

Most denials are decided before the visit happens.

Eligibility runs at booking and again before the date of service, so a terminated plan or a changed policy surfaces while there is still time to fix it. Prior authorization requirements are checked against the payer and the CPT®/HCPCS code at the moment of order or scheduling — the requirement appears before the service is rendered, not on the remittance. Requests are submitted electronically where the payer supports it, tracked in a work queue with status, units remaining and expiration, and attached to the encounter so the claim carries the authorization number without anyone looking it up. Patient responsibility is estimated from the live benefit response, so the front desk collects the right amount instead of guessing or collecting nothing.

→ Eligibility at booking and again before the date of service
→ Auth requirements checked by payer and procedure code
→ Auth work queue with status, units and expiration alerts
→ Patient responsibility estimated from the live benefit response

yourpractice.clovai.app / billing

Revenue Cycle

Front of the cycle

Re-keying from chart to claim

837P/I

Direct or through your clearinghouse

1 Eligibility at booking and again before the date of service

2 Auth requirements checked by payer and procedure code

3 Auth work queue with status, units and expiration alerts

4 Patient responsibility estimated from the live benefit response

Care™ — charges built from the signed encounter

Front of the cycle — Clovai Billing™ · illustrative interface

Charge capture & scrubbing

The scrubber catches it. Not the payer, forty-five days later.

When the provider signs the note, charges are built from what was documented — diagnoses, procedures, modifiers, units, place of service and rendering provider all carried forward without a second person typing them again. Before submission, every claim runs the edit stack: NCCI procedure-to-procedure and medically-unlikely edits, LCD and NCD medical-necessity checks, modifier appropriateness, payer-specific rules, and the demographic and coverage validations that cause front-end rejections. Anything that fails goes to a work queue with the reason in plain language and the fix one click away. The claim that leaves the building is the claim that gets paid — and the ones that would have been denied never became denials.

→ Charges built from the signed note — no re-keying
→ NCCI PTP and MUE edits applied pre-submission
→ LCD/NCD medical-necessity and modifier validation
→ Payer-specific rules and front-end rejection prevention

yourpractice.clovai.app / billing

Revenue Cycle

Charge capture & scrubbing

Re-keying from chart to claim

837P/I

Direct or through your clearinghouse

1 Charges built from the signed note — no re-keying

2 NCCI PTP and MUE edits applied pre-submission

3 LCD/NCD medical-necessity and modifier validation

4 Payer-specific rules and front-end rejection prevention

Care™ — charges built from the signed encounter

Charge capture & scrubbing — Clovai Billing™ · illustrative interface

Payment, denials & A/R

Denials get worked by root cause. A/R gets worked before it ages out.

837P and 837I claims go out through your clearinghouse or ours, with 277CA acknowledgments reconciled so nothing sits in a black hole. Electronic remittances post automatically — payments, adjustments and patient responsibility applied by line, with contractual variance flagged when the payer pays below the contracted rate, which is how underpayments stop being invisible. Denials land in worklists grouped by CARC/RARC root cause rather than by date, with appeal templates, the supporting documentation already attached, and the appeal deadline on the clock. A/R is visible by payer, by age bucket and by responsible party, with a timely-filing countdown per payer so nothing is written off because a calendar was ignored.

→ 837P/837I submission with 277CA reconciliation
→ 835 auto-posting with contractual variance detection
→ Denial worklists grouped by CARC/RARC root cause
→ A/R by payer and age with timely-filing countdowns

yourpractice.clovai.app / billing

Revenue Cycle

Payment, denials & A/R

Re-keying from chart to claim

837P/I

Direct or through your clearinghouse

1 837P/837I submission with 277CA reconciliation

2 835 auto-posting with contractual variance detection

3 Denial worklists grouped by CARC/RARC root cause

4 A/R by payer and age with timely-filing countdowns

Care™ — charges built from the signed encounter

Payment, denials & A/R — Clovai Billing™ · illustrative interface

Capabilities

What Clovai Billing™ includes

Built for U.S. ambulatory operations. Configured and ready from day one.

🪪

Real-time eligibility (270/271)

At booking and before the date of service. Plan status, copay, coinsurance, deductible remaining and termination dates.

🔐

Prior authorization management

Requirement check by payer and code, electronic submission (278) where supported, work queue with units and expiration tracking.

🧾

Charge capture from the chart

Diagnoses, procedures, modifiers, units, POS and rendering provider carried from the signed note. Nobody types it twice.

🧹

Claim scrubbing

NCCI PTP and MUE, LCD/NCD medical necessity, modifier logic, payer rules and demographic validation — before submission.

📤

Claims submission

837P and 837I through your clearinghouse or ours. 276/277 status inquiry and 277CA acknowledgment reconciliation.

💰

ERA auto-posting

835 remittances posted by line with adjustments and patient responsibility applied, plus contractual variance and underpayment detection.

⚡

Denial management

Worklists grouped by CARC/RARC root cause, appeal templates, attached documentation and deadline tracking.

👤

Patient billing and estimates

Statements, online payment, payment plans, card on file, and Good Faith Estimates for self-pay under the No Surprises Act.

Native integration

Clovai Billing™ talks to the entire platform

No interfaces to build. No HL7 feeds to maintain. No per-transaction integration fees. Data flows between pillars from day one.

← Back to all pillars

Care™ — charges built from the signed encounter

Scheduling™ — eligibility and copay captured up front

Finance™ — every posted remit becomes a journal entry

Intelligence™ — A/R days, clean claim rate and denial analytics

Clovai Billing™

Most denials are decided before the visit happens.

The scrubber catches it. Not the payer, forty-five days later.

Denials get worked by root cause. A/R gets worked before it ages out.

What Clovai Billing™ includes

Real-time eligibility (270/271)

Prior authorization management

Charge capture from the chart

Claim scrubbing

Claims submission

ERA auto-posting

Denial management

Patient billing and estimates

Clovai Billing™ talks to the entire platform

Want to see Clovai Billing™ in action?