Claims
Claim builder
A guided way to write a clean professional claim the first time. The claim builder walks a biller through a professional (837P) claim one decision at a time: patient and coverage, provider and place of service, lines, diagnoses, attachments. Institutional (837I) claims are supported in the product too. Most billing teams we spoke to still assemble claims by copying fields from three or four places. What ships here includes professional (837p) claim creation with a step-by-step wizard; institutional (837i) support inside the product. Used day to day by biller, supervisor, admin roles, with availability marked available. Open the sample screen on the right, then walk the steps below — or book a demo and put your hand on the same flow with synthetic data.
CLM-24-08812 · J. Alvarez · Lakeview Ortho
Scrub results
Lines
What it is
The claim builder walks a biller through a professional (837P) claim one decision at a time: patient and coverage, provider and place of service, lines, diagnoses, attachments. Institutional (837I) claims are supported in the product too.
The problem it solves
Most billing teams we spoke to still assemble claims by copying fields from three or four places. Each copy is a chance to transpose an NPI or drop a modifier, and nobody notices until the payer says no a few weeks later.
Process
How it works, step by step
- 1
Start from the encounter
Pick the practice and patient. Coverage you've already verified comes along with it, so you aren't retyping member IDs.
- 2
Add the service lines
Enter procedures, units, charges and diagnosis pointers in a layout that mirrors the claim form, not a generic data grid.
- 3
Attach what the payer needs
Operative notes or other supporting documents ride with the claim as attachments (PWK), instead of living in someone's inbox.
- 4
Hand it to the scrubber
When you save, the claim moves straight into rules-based validation. Nothing is sent yet.
What's included
Everything below is part of claim builder today.
- Professional (837P) claim creation with a step-by-step wizard
- Institutional (837I) support inside the product
- Coverage carried over from eligibility checks
- Diagnosis pointers and line-level modifiers
- Supporting document attachments (PWK)
- Drafts you can leave and pick up later without losing work
The guardrail
Saving a claim never sends it. A claim only leaves MEDBIX after someone on your team approves it.
Where it fits: claim status lifecycle
Claims move through clear states. Lists are honest because status changes come from real actions, not someone remembering to update a cell.
- Person decides
- MEDBIX
- 1
Draft
Person decidesBeing built or corrected.
- 2
Validating / ready
MEDBIXScrub rules have run.
- 3
Pending review
Person decidesWaiting for an approver.
- 4
Approved
Person decidesSigned off by a person.
- 5
Queued
MEDBIXLined up for the clearinghouse.
Audience
Who uses it
These roles work with this feature day to day. Access always follows what your admin assigns.
Works closely with
Deep dive
What Claim Builder means in daily ops.
Practical context for Claim Builder: how teams use it, where it sits in the loop, and what to ask in a demo.
- Tied to how billing work actually splits
- Clear on human vs machine responsibility
- Links into related MEDBIX areas
Practice
Where this shows up on a busy day.
From morning eligibility checks to end-of-day posting, Claim Builder connects to the queues your team already lives in.
- Morning coverage and claim build
- Midday scrub and approval
- Afternoon denials and patient pay
Control
Keep a person on the send button.
Whatever page you're on, MEDBIX keeps AI in a propose role. Approvals, posting and rule activation stay human.
- Named approvals
- Visible AI proposals
- Immutable audit trail
Next
See Claim Builder against your volume
Bring your payer mix and the friction you feel today. We'll map it onto sample data in thirty minutes.
- Sample data only
- Your questions drive the agenda
- Written follow-up after
Common questions
Do we have to use the wizard every time?
No. It's there to keep new billers from missing fields. Experienced staff can move through it quickly, and drafts can be edited directly.
Can we bill institutional claims?
Yes, 837I is supported in the product. Most of our early focus has been professional claims, so tell us about your institutional volume on a demo and we'll show you exactly what's covered.
Where do attachments go?
They stay linked to the claim, so whoever works a later denial can see what was originally sent.
Want to walk MEDBIX against your real claim mix?
Thirty minutes with sample data. We'll follow one claim through the gate, then talk about your payers, practices and where the rework hurts today.
Notes from the billing floor
Occasional, practical writing on denials, A/R and running a billing company. No spam, unsubscribe any time.