Workflow
From insurance on file to money in the bank, in one 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. Walk the diagram below to see who acts at each step — a person, MEDBIX, an AI agent, the clearinghouse, or money moving — and where a named decision is required.
Diagram
The steps
Each step shows who acts: a person, MEDBIX, an AI agent, the clearinghouse, or money moving.
- 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
The principles behind it
One system of record
Eligibility, claims, money and patient balances share the same data.
Humans at the money moments
Approval before submit; posting by people.
Every branch has an owner
Paid, patient-owed and denied paths each lead somewhere specific.
Ownership
Who does what
| Who | What they do in this workflow |
|---|---|
| Biller | Eligibility, claim building, scrubbing, denials. |
| Supervisor | Approvals, queue balancing, oversight. |
| Accountant | Posting, aging, statements, reports. |
| Admin | Practices, users, rules and integrations. |
Features in this workflow
On the floor
What this looks like in practice
These cues come from the same workflow — useful when you are mapping MEDBIX to how your team already works.
system
Patient & insurance on file
Demographics and coverage, from import, EHR ingest or entry.
external
Eligibility (270/271)
Coverage confirmed through the clearinghouse before billing.
human
Charge capture → claim draft
Encounter becomes a draft claim in the builder.
Next
Walk it live, or open a related feature
A demo follows this path with synthetic data. Feature pages spell out capabilities, roles and guardrails for each piece.
Other workflows
Claim status lifecycle
Every status a claim can be in, and how it gets there.
The human approval gate
AI can suggest. Only your team can send.
Denial workflow
From denial to resubmission, with a person at the wheel.
Patient payment workflow
From balance to paid, in the fewest taps possible.
Tenancy model
Billing company on top. Practices underneath. Walls in between.
Deep dive
What Rcm Loop means in daily ops.
Practical context for Rcm Loop: 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, Rcm Loop 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
Walk Rcm Loop live
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 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.
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.