The core of your claims operation
Configure billing, pricing, payment, and AR management to fit how your organization works, and automate the repetitive parts. Every module is HIPAA compliant by design.
Talk to our team →Core capabilities
Adjudication & repricing
Price every claim against custom payor and provider contracts.
Payments, advances & recoupments
Track payments, denials, and reversals through a configurable rule engine.
Contract management
Manage fee schedules online without duplicating data across contracts.
Integrated work queues
Keep teams on track with queues that surface what needs attention.
EOP/835 & EFT/ACH/check generation
Generate remittances and payments in the formats payors expect.
Templated letter generation
Produce Medicare-compliant letters from reusable templates.
Price claims the way your contracts actually work
Most of our clients price claims against custom contracts with both the payor and the provider: risk-based per-member-per-month, percentage-of-allowable, fee-for-service, and others. Claims-Flow handles all of them.
Every detail of a claim, on one screen
Adjudication results, linked appeals, payment history, and notes all live together on the claim, so your team doesn't have to hunt across systems to answer a question.
Automated 835 processing
Our rule engine processes 835s and handles payments, denials, and reversals automatically, which cuts the time your team spends on reconciliation.
Create and parse the files payors require
Built-in tooling creates and parses institutional and professional ANSI files (837, 835, 999, 277, and others) against current X12 specifications.
Automation across the claim lifecycle
From intake and authorization through appeals, the approach is the same: define the rules once, and Claims-Flow does the repetitive work.
See Claims-Flow on your data
We'll walk you through how the core modules map to your operation.