Process
How a claim moves through MEDBIX.
Six workflows describe the whole platform, from patient coverage on file through remittance and patient pay. Start with the full revenue cycle loop to see how a claim moves end to end in one place. Then open any step that matters to your team — the claim lifecycle, the human approval gate, denials, patient payments or tenancy. Each workflow page walks the diagram, who acts at each node and where a person must decide. Along the way, agents can explain eligibility responses, scrub findings and denial patterns, but every proposal stays visible and every send stays a person's. If you want the same path against sample data, book a demo and put your hand on the gate.
RCM loop
The full RCM loop
This is the whole job of a billing company, end to end. Every step lives in MEDBIX, so nothing falls into the gap between two tools.
- MEDBIX
- Clearinghouse / payer
- Person decides
- Money moves
- 1
Patient & insurance on file
MEDBIXDemographics and coverage, from import, EHR ingest or entry.
- 2
Eligibility (270/271)
Clearinghouse / payerCoverage confirmed through the clearinghouse before billing.
- 3
Charge capture → claim draft
Person decidesEncounter becomes a draft claim in the builder.
- 4
Deterministic scrub
MEDBIXRules run; AI can explain any finding.
- 5
Human review & approve
Person decidesRequired before anything leaves.
- 6
Submit (837)
Clearinghouse / payerApproved claims go to the clearinghouse.
- 7
Claim response
Clearinghouse / payerAccepted, rejected or correction required.
- 8
Remittance (835) → posting
Money movesPayments posted to an append-only ledger.
Closed
Statement → portal / pay link
Work queue → fix → review → resubmit
Catalog
All six workflows
Each page walks the steps, who does what, and where a person must decide.
The full RCM loop
From insurance on file to money in the bank, in one loop.
8 steps
Claim status lifecycle
Every status a claim can be in, and how it gets there.
7 steps
The human approval gate
AI can suggest. Only your team can send.
4 steps
Denial workflow
From denial to resubmission, with a person at the wheel.
5 steps
Patient payment workflow
From balance to paid, in the fewest taps possible.
4 steps
Tenancy model
Billing company on top. Practices underneath. Walls in between.
3 steps
Where the machine helps along the way
Agents run on human-in-the-loop workflows. Every proposal stays visible; every decision stays a person's.
- Eligibility review: explains 271 responses
- Coding assist: suggests codes, accepted one at a time
- Scrub explain: plain English for rule findings
- Denial intelligence: fixes from your resolved denials
- Payer intelligence: suggested rules an admin approves
Handoffs
What changes between steps
Each workflow owns one job. Together they keep coverage, claims, money and patient balances from living in five tools that never agree.
Before a claim exists
Eligibility and coding set coverage and codes while the encounter is still fresh — not after a denial arrives.
Before anything is sent
Build, scrub and a named approval gate sit between a draft and the clearinghouse.
After the payer answers
Denials and A/R prioritize what is worth working; remittance posts into one ledger.
When the patient owes
Statements and pay links use the same balances the accountant already posted.
Try it
Same path, sample data
A demo follows one claim through the loop so you can put your hand on the amber gate — not watch a slide deck.
Loop
Follow one claim from eligibility to paid.
Six workflows describe the whole platform. Start with the revenue cycle loop, then open the steps your team cares about most.
- Eligibility before the claim is built
- Scrub findings in plain English
- Human approval before the 837 leaves
Gate
The amber step is a person with a name.
Every workflow shares one rule: AI can propose, only your team can send. That keeps accountability where billing companies need it.
- Visible proposals, human decisions
- Audit trail on approvals and returns
- Same gate across claims and rules
Denials
Work denials as a queue, not an inbox.
Prioritize by dollars and risk. Pull fixes from denials you've already solved — still applied by a person.
- Priority by amount and denial type
- Intelligence that suggests, never auto-resubmits
- Clear ownership per practice
Money
Posting, aging and patient pay in one ledger.
Remittance lands where aging lives. Statements and pay links stay attached to the same patient record your billers already know.
- ERA posting without spreadsheet export
- Aging that matches what accountants see
- Patient pay without card data in MEDBIX
Common questions
Do we have to use every step?
No, but the value grows when the whole loop lives in one place.
Where does AI fit?
Explaining, suggesting and prioritizing at several steps. Never deciding.
Why not let AI submit trusted claims?
Because the billing company is accountable for every claim, and accountability needs a person.
Does the gate apply to corrections?
Yes, every resubmission too.
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.