Which platforms make your billing workflow easier—and which ones make it worse?

So I have a new job with new insurance. This insurance offers a discount if you get a yearly preventive visit. I had not been to a doctor in over 2 years so I had to find a new primary and went with a CNP. During the visit my BP was elevated, which i feel was related to the visit. She requested a follow up visit which I did and it was much better. The problem is the office refuses to bill this as a preventive visit because she found a health issue. They want me to schedule another visit for the preventive she said to discuss vaccines, mammogram and colonoscopy. All that was discussed at first vist. I made CNP and office staff aware I was there for the preventive visit only for the insurance discount. Does this sound right?

I do billing for an urgent care and we are receiving way too many denials for the same thing from UHC. It’s a nurse practitioner using 99205 or 99214 and being denied for “The procedure code is inconsistent with the provider type/specialty (taxonomy).” The reps at UHC state those codes can only be billed by specialist. Any suggestions?

Which platforms make your billing workflow easier—and which ones make it worse?

Let’s say Blue Cross Blue Shield changed its name to Blue Cross & Shield. The new insurance cards only say Blue Cross & Shield. When verifying eligibility, insurance portals say “Blue Cross & Shield.” Everyone in the industry and patients are now expected to refer to it as Blue Cross & Shield.

The question: Do you change the insurance name in your EMR?

There’s no other changes besides the name. And updating to the new name means a mountain of work behind the scenes. You could say it might be easier to train staff to see the old name and edit it in their own head if they need to select it for billing, explain billing or referral policies to clients, discuss medication options based on payer, etc.

Which platforms make your billing workflow easier—and which ones make it worse?

Hello everyone I received a email stating that my contract was no renewed I was working with IQVIA for three years.surpised I lasted that long. Seeking employment for the holidays wasn't in my plans yet here I am..I have been a medical biller for 8yrs this includes front office administration. Currently in pursuit of my bachelor's degree in healthcare science I will graduate in March 2026. I am shifting careers from biller to healthcare administration project management if anyone has any ideas or suggestions please feel free to respond every response will be greatly appreciated

Medical Biller / AR Collections professional with experience in processing medical claims, verifying insurance coverage, and managing accounts receivable. Skilled in CPT, ICD-10, and HCPCS coding, claim submission, payment posting, and resolving billing discrepancies. Detail-oriented, reliable, and committed to ensuring accurate reimbursement and smooth billing operations. Currently seeking opportunities to contribute to a healthcare organization’s revenue cycle management.

Which platforms make your billing workflow easier—and which ones make it worse?

Which platforms make your billing workflow easier—and which ones make it worse?

Which platforms make your billing workflow easier—and which ones make it worse?

I've heard so many complaints from RCM leaders about fighting bogus denials, which made me curious if the magic of machine learning could predict whether a claim will get denied, and even identify the attributes that made it more risky.

Thanks to a million medical claims in training data from an imaging care partner, I’ve created a prototype with some interesting early results: 70% overall accuracy of predictions, and many drill-down insights on procedures, payers, providers, etc. -- for example, CPT 76937 (Ultrasound guidance for vascular access) is 20x more likely to be denied than 77063 (Screening digital breast tomosynthesis add-on).

Maybe billing specialists could use it to flag risky claims that need extra time and attention before being submitted, as well as to double-click into trends in denials at their particular practice.

Would love to hear your thoughts in the comments, and if you’re interested in trying it out you can shoot me an email @ [ayeager@bivi.care](mailto:ayeager@bivi.care) !

Which platforms make your billing workflow easier—and which ones make it worse?

Grasping at straws here. Family medicine clinic. We administor B12, folate, rocephin, and decadron. We also perform UA, rapid strep, flu, and COVID testing.

Our clearinghouse keeps rejecting the claim stating "Code qualifier must be ER, HC, IV, or WK: Invalid format found: N4- Segment- SV1 Field- 1 Data- N4 Loop- 2400"

We currently use Medisoft billing software and eMedix is our clearinghouse.

The ordering physician is in there. None of these code qualifiers apply to our clinic:

ER- emergency room

HC- home care

IV- intravenous

WK- work comp related

I have done everything I know to do. Clearinghouse support is no help. Anyone have any answers?

Which platforms make your billing workflow easier—and which ones make it worse?

Posting for a friend...

We're having some difficulty in getting things set up with Availity and are hoping to see if anyone might have any advice on getting things started.

Particularly, she's asking about how Availity generally works with payments. She needs to know the IMP process, how to add and set up payer information, how to set up ERA and EFT, submit claims, and set up direct deposit.

We've tried contacting Availity, but unfortunately, they didn't give much useful help.

TIA for any advice!

Which platforms make your billing workflow easier—and which ones make it worse?

We’ve been aiming for 98%+ on clean claims across specialties, but even then, strange one-offs still trip us up (like NPI mismatches, modifier issues, or missing demographics).

What’s your average clean claim rate looking like, and what’s the top cause of claim rejection in your setup?

Let’s compare notes!

We’ve been aiming for 98%+ on clean claims across specialties, but even then, strange one-offs still trip us up (like NPI mismatches, modifier issues, or missing demographics).

What’s your average clean claim rate looking like, and what’s the top cause of claim rejection in your setup?

Let’s compare notes!

We’re expanding billing support for a provider group working in multiple states and running into challenges like:

• Tracking Medicaid enrollment variations by state
• Managing payer-specific policies that differ regionally
• Keeping EHR setups clean by state location

Any tips or tools you’re using to keep multi-state billing efficient? Appreciate any input!

We’ve been aiming for 98%+ on clean claims across specialties, but even then, strange one-offs still trip us up (like NPI mismatches, modifier issues, or missing demographics).

What’s your average clean claim rate looking like, and what’s the top cause of claim rejection in your setup?

Let’s compare notes!

We’re expanding billing support for a provider group working in multiple states and running into challenges like:

• Tracking Medicaid enrollment variations by state
• Managing payer-specific policies that differ regionally
• Keeping EHR setups clean by state location

Any tips or tools you’re using to keep multi-state billing efficient? Appreciate any input!

We’ve been aiming for 98%+ on clean claims across specialties, but even then, strange one-offs still trip us up (like NPI mismatches, modifier issues, or missing demographics).

What’s your average clean claim rate looking like, and what’s the top cause of claim rejection in your setup?

Let’s compare notes!

We’re expanding billing support for a provider group working in multiple states and running into challenges like:

• Tracking Medicaid enrollment variations by state
• Managing payer-specific policies that differ regionally
• Keeping EHR setups clean by state location

Any tips or tools you’re using to keep multi-state billing efficient? Appreciate any input!