MedCare Docs
Feature Guide

Claim Submission

AI-powered claim generation with automated code mapping and submission tracking

Overview

The Claim Submission module automates the entire claims process from code selection to submission. Our AI agent analyzes patient care records, selects optimal diagnosis and procedure codes, and submits claims directly to insurance providers.

Submission Timeline

  1. Step 1
    Fetching Patient Info:

    System retrieves patient demographics, care history, and insurance details from records

  2. Step 2
    AI Code Analysis:

    AI agent analyzes care events and calculates optimal ICD-10, CPT, and HCPCS codes

  3. Step 3
    Insurance Cross-Check:

    System validates codes against patient's insurance policy and coverage rules

  4. Step 4
    Claim Submission:

    Formatted claim is submitted electronically to insurance company via EDI

Visual Progress Tracking

When you click "Submit Claim" for a patient, an animated progress timeline appears showing each step in real-time:

  • Horizontal Progress Bar: Fills from 0% to 100% as steps complete
  • Step Indicators: Each step shows a loading spinner while processing
  • Completion Checkmarks: Green checkmarks appear when steps finish successfully
  • Timeline Collapse: Progress timeline collapses after completion, showing final status

Claim Status Types

Submitted

Claim has been sent to insurance and is awaiting review

Pending

Claim is under review by insurance company

Approved

Claim approved - payment will be processed

Denied

Claim denied - review reason and consider resubmission

Action Buttons by Status

  • No Status: "Submit Claim" button to initiate submission process
  • Pending/Submitted: "View Details" button to see claim information
  • Approved: "View Details" button to see payment information
  • Denied: "Retry Claim" button to resubmit with corrections

AI Code Mapping

Our AI agent uses advanced algorithms to select the most appropriate medical codes:

  • ICD-10 Codes: Diagnosis codes based on patient symptoms and conditions
  • CPT Codes: Procedure codes for treatments and services performed
  • HCPCS Codes: Healthcare Common Procedure Coding System for supplies and equipment

Claim Response Handling

Automatic Status Updates

System polls insurance provider for claim status updates and automatically updates the dashboard

Denial Reason Analysis

When claims are denied, AI analyzes the reason and suggests corrections for resubmission

Payment Tracking

Approved claims are tracked through payment processing with expected payment dates

Best Practices

  • Verify insurance coverage before submitting claims
  • Ensure all care timeline events are documented
  • Review AI-selected codes for accuracy before submission
  • Monitor claim status regularly for updates
  • Address denied claims promptly with corrected information