Difference between revisions of "OpenEMR 6.x Billing - Claims Workflows"

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...this page might be under construction for the next few days...
Billing: Submit Claims
= Introduction =
= Introduction =


OpenEMR's billing module is deep and complex; this document only shows the claims and invoice- related activities. Being as comprehensive as they are, the billing workflows depend on settings and data from other parts of the EMR in order to accurately fulfill their missions. Those requirements will not be detailed here, but they do need to be in place for claims to be successfully processed.
* Be sure the Facility and Practice settings, Patient demographics and insurance information are correct<br>
[[List_of_OpenEMR_Data_Fields_Required_For_Insurance_Claims]]
* The encounter(s) to be billed must be complete; see <br>
[[HOWTO:_Create_A_Claim-_Ready_Encounter]]
* And, of course, the practice must have an account with a compatible clearinghouse<br/>




OpenEMR's billing module is an integrated set of many functionalities that handle all the aspects of billing that OpenEMR provides. This document only shows the claims- related activities.
A few things to remember:<br>
* I am not an accountant or a billing professional! So I have borrowed terminology extensively from the billing documentation for older versions of OpenEMR . Particularly, [[Accounting_%26_Receivables_4.1]]
* If you have ANY billing questions go to the forum at https://community.open-emr.org/c/clinical-users/6 and ask the day-to-day users. Many forum readers have been using the OpenEMR billing module for many years and are happy to share their experience.
* Also: most of the dropdown lists seen in this module may be customized. See other instructions in the wiki on using the List Editor.




Being as comprehensive as they are, the claims workflows depend on settings and data from other parts of the EMR in order to fulfill their missions. Those requirements will not be detailed here, but they do need to be properly in place for claims to be successfully processed.* Be sure the Facility and Practice settings; Patient demographics <nowiki>and insurance information are correct [[List_of_OpenEMR_Data_Fields_Required_For_Insurance_Claims]]</nowiki>
The entire claim processing workflow can be arbitrarily divided into six major steps which I have placed into the following two wiki pages:
* The encounter<nowiki>(s) to be billed must be complete; see [[HOWTO:_Create_A_Claim-_Ready_Encounter]]</nowiki>
* And, of course, the practice must have an account with a compatible clearinghouse<br/>


Page 1, Claims Creation - this wiki page<br>
* Generate Paper Claims
** CMS 1500
** Pt Invoicing
* EDI: Generate X12 Claims In OpenEMR
* EDI: Upload X12 Files To Clearinghouse
<br>
Page 2, [[OpenEMR_6.x_Billing_-_Process_Payments]]<br>
* Manual Payments
** Search for Payments
** Patient payments or EOBs
* EDI: Claims Response Files
* EDI: Apply ERAs


OpenEMR's Billing Manager can generate either x12 claim batch files for electronic claim submission, and HCFA claim forms for postal mailing to the payer. X12 files are automatically saved to the designated download directory or folder of the billing user's browser, from where they may be uploaded to a clearinghouse. HCFA forms are saved as text or PDFs to that same download location, from where they may be sent to a printer attached to the billing user's computer. The workflows for both X12 and HCFA claim files are nearly the same; the variations will be mentioned at the appropriate places in the instructions below.


Please DM me on the forum if you have any questions about this documentation, or to point out any errors of fact I may have committed here!
* HTuck - MI-Squared.com


The entire claim workflow can be divided into five major steps which will be divided into the following two wiki pages:
= Claims Creation =


Claim creation is the same no matter what format they will be sent out as; x12 files, paper CMS1500 forms or postal- mailed invoices.


Page 1, Billing: Submit Claims - this wiki page
Having in place all the prerequisites mentioned above, the claims submission process all begins here: from the OpenEMR main menu, click 'Fees/ Billing Manager'; see the opening screen.
:Step 1. Generate Claims In OpenEMR
:Step 2. Upload To Clearinghouse
:Step 3. Check For Response Files


Page 2, [[OpenEMR 6.x Billing: Process Payments]]
''Note: unlike many OpenEMR functions, the Billing Manager may be operated without a patient record open.''
:Step 4. Download Response Files
:Step 5. Apply Payments




''Note: Most screenshots were taken on an OpenEMR v6.0(3) install but new interface changes are anticipated soon so more modern versions may look slightly different.''
[[Image:bl01.png]]








= Billing - Submit Claims =


1. Search for the claims - the search criteria will open different types of smaller panels in which to specify the search terms:




Having in place all the prerequisites mentioned above, the claims submission process all begins here: from the OpenEMR main menu, click 'Fees/ Billing Manager'; see the opening screen.
* All date criteria have date pickers
[[Image:bl02.png|center]]




''Note: unlike many OpenEMR functions, the Billing Manager may be operated without a patient record open.''






[[Image:bl01.png|center]]


* The list- formatted data will show what has been configured in the EMR. See here the insurance company provided by 'Practice Settings/ Insurance Companies'
[[Image:bl03.png|center]]


= Step One: Generate Claims In OpenEMR =


1. Search for the claims - the search criteria will open different types of smaller panels in which to specify the search terms:


:* All date criteria have date pickers
[[Image:bl02.png|center]]








* Any simple text criteria will merely have a text input area (not pictured)<br/>


As they are input, the search terms are added to 'Current Criteria' (round rectangle)




:*The list- formatted data will show what has been configured in the EMR. See here the insurance company provided by 'Practice Settings/ Insurance Companies'
[[Image:Bl04.png]]
[[Image:bl03.png|center]]




Line 70: Line 81:




:* Any simple text criteria will merely have a text input area (not pictured)<br/>








As they are input, the search terms are added to 'Current Criteria' (round rectangle)
If you want to remove any terms from the Current Criteria, the yellow trash can deletes the selected one (here, Date of Service); the red can deletes them all.




[[Image:bl04 .png|center]]
[[Image:bl05.png|center]]




Line 85: Line 95:




If you want to remove any terms from the Current Criteria, the yellow trash can deletes the selected one (here, Date of Service);<br>
...the red can deletes them all.
[[Image:bl05.png|center]]




Line 98: Line 103:
2. Click 'update list' to generate the list of claims
2. Click 'update list' to generate the list of claims
[[Image:bl06.png|center]]
[[Image:bl06.png|center]]






''Find the following lettered items in the picture below''
''Find the following lettered items in the picture below''


:a. look in the 'Expand' link to see the claim history (the display opens up, as Pepe's item shows)
:a. look in the 'Expand' link to see the claim history (the display opens up, as Pepe's item shows)


''Note: a red patient name (e.g., Pepe's) means something is wrong in insurance info... his has no insurance company selected.''
''Note: a red patient name (e.g., Pepe's) means something is wrong in insurance info... in this case his has no insurance company selected.''


:b. check that each claim has all the required elements:<br>
* 'Bill' Insurance and 'X12' entities are selected
* the CPT4 or other service code (oval) given for the service(s) rendered in that encounter
* the justifying ICD10 diagnosis code (rectangle) for each CPT code
* the fee (arrow) for each CPT code
* the rendering provider (yellow highlight) for each line item
* Date of Service<br/>


:b. check that each claim has all the required elements:
:c. each claim component may be edited from this claim listing** click on 'Encounter' (left blue button under name) to open the encounter summary form to fix things wrong with the encounter/ fee sheet
:* both the 'Bill' (insurance) and 'X12' dropdowns are selected
* click on 'Patient' (right blue button next to insurance company name) for demographics or insurance company information errors<br/>
:* the CPT4 or other service code (oval) given for the service(s) rendered in that encounter
:* the justifying ICD10 diagnosis code (rectangle) for each CPT code
:* the fee (arrow) for each CPT code
:* the rendering provider (yellow highlight) for each line item
:* Date of Service<br/>


[[Image:bl07.png|center]]


:c. each claim component may be edited from this claim listing
:* click on 'encounter' to open the encounter summary form to fix things wrong with the encounter/ fee sheet
:* click on 'Patient' for demographics or insurance company information errors<br/>
[[Image:bl07.png|center]]




Line 128: Line 132:


3. Click 'Clear Log' (oval below) before validating this batch of claims
3. Click 'Clear Log' (oval below) before validating this batch of claims
[[Image:bl07-clearLog.png|center]]
[[Image:bl07-clearLog.png|center]]


Line 133: Line 138:




4. Select specific claims (individual checkbox, at far right in Pepe's claim, above) or 'Select All' (arrow in previous pic)


5. Generate the claim printout files




* '''HCFA claims'''  
Once the claims being processed have been validated and all necessary components verified, the claims may be sent out, either by electronic or paper media.
 
 
== Generate Paper Claims ==
Once you have selected the claims to be submitted, proceed with which sort of claim will be generated:  CMS 1500 claim forms or Patient invoices.
<br>
 
=== CMS 1500 ===
 
# HCFA claims - Click the 'HCFA FORM' dropdown
# then select desired claim file format, .txt or .pdf
 
[[Image:Bl08-claim-genHCFA.png]]
 
 
 
 
 
 
 
 
* The file will be saved in the browser's designated local download location.
* The data is laid out on the page to fit into the text areas on the form
* It may be sent to a printer which has been loaded with the authorized pre- printed HCFA claim forms.
 
 
[[Image:bl08-claimHCFApdf.png|center]]
 
=== Patient Invoicing ===
 
Once all the payments from the insurance companies have been received and entered for an account, you can generate invoices from OpenEMR's EOB page to directly bill patients for the remaining amounts.
 
 
'''''Note: any user with 'Accountant' or 'Administrator' ACL may generate invoices'''''
 
 
1. Open the EOB page to generate invoices, at the main menu item: 'Fees/ Posting Payments'
 
 
[[Image:inv1-eob00.png|center]]
 
 
 
 


:: '' *** be sure to have the checkbox selected in Globals/ Billing:''<br>
[[Image:cms1500ckbx.png|center]]<br>
''and the other CMS 1500 settings as desired ***''




[[Image:bl08-claim-genHCFA.png|right]]
- Click the 'HCFA FORM' dropdown




* then select desired claim file format, .txt or .pdf
In the 'Invoice Search' section note radio button 'Invoice Search' (oval)
** The file will be saved in the browser's designated local download location.
** The data is laid out on the page to fit into the text areas on the HCFA claim form
** It may be sent to a printer which has been loaded with the pre- printed HCFA forms.


selected by default


[[Image:bl08-claimHCFA_pdf.png|center]]




[[Image:inv1-eob01.png]]


2. Search for invoices by:




* Patient Name
* Chart ID (PID or External ID)
* Encounter number
* Service date From/ To - get all invoices in that range
* Type: see the list in picture
[[Image:inv1-eob02.png|center]]
3. Enter search criteria click 'Search' (blue button in previous pic)
4. See list of invoices matching the search
'''''** remember: the ad-hoc simulated data pictured here do not accurately represent properly constructed claims **'''''
The columns are self explanatory, except 'Prv' which older -version docs say 'indicates the number of insurance companies for which this invoice is awaiting payment.'
[[Image:inv1-eob03.png]]
5. Select the checkboxes (column 'Sel') of the invoices to be printed.
6. Per the button bar at the bottom:<br>
* 'Select all' - invoices displayed
* Clear all - that have been selected
* PDF Download Selected - print to pdf the selected invoices into the current user's Downloads directory from where they can be printed out for postal mailing.
* Email Selected - to patient, if patient email notifications have been set up
* Notify Patients Portal - what it says: send a message to the patients' portal account.
[[Image:inv1-eob05.png|center]]
'''''Note: see the wiki page https://www.open-emr.org/wiki/index.php/Accounting_%26_Receivables_4.1#Patient_Invoices_and_Payments'''''
'''''for another description of this process.'''''
Alternatively one may click on the invoice number (3d column in previous pic) to see its details, to make adjustments or whatever, then print the invoice for sending.
[[Image:inv1-eob04]]
== EDI: Generate X12 Claims In OpenEMR ==
The electronic version of paper invoicing is, of course, generating and submitting x12 claim files to a clearinghouse.<br>
[[Image:bl08.png]]
To continue from the Billing Manager workflow last pictured above in step 3 of first section, 'Claims Generation' in this page:
1. Instead of clicking 'HCFA Form', click 'X12 Options'
then:
:'Generate X12'
''Find the lettered items in the list below, in the following picture''
[[Image:bl09.png|right]]
:a. First: click x12 Options/ Validate Only


*'''X12 claims''' -


:Generate the claim batch file:


[[Image:bl08.png|center]]




''Find the lettered items below in the following picture''




:a. First: click 'X12 Options', 'Generate X12' then 'Validate Only'


[[Image:bl09.png|center]]




Line 184: Line 295:
:The X12 file displays.
:The X12 file displays.


... then click 'Logs' at the bottom (oval lower right) to see if the validation log has errors


:b. Click 'Logs' button (oval lower right) to see if any problems have been registered in the claim validation logs.


[[Image:bl10.png|center]]


[[Image:bl10.png]]




Line 194: Line 305:




The validation log is another place to find what errors exist in the claim file that will prevent it from being accepted.
:*Claims with errors may be either corrected from the claim list and re- validated til clear of errors, or simply unselected from the list. That claim will be excluded from the batch file but will re-appear next time a search is done that includes it.






[[Image:bl11.png]]
 
 
The validation log is another place to find what errors exist in the claim file that will prevent it from being accepted by the clearinghouse or insurance company.
 
 
The errors may be either corrected from the claim list and re- validated til clear of errors, or simply unselect the claims from the list. That claim will be excluded from the batch file but will re-appear next time a search is done that includes it.
 
 
 
 
[[Image:bl11.png|right]]




To finish the claim generation process:
To finish the claim generation process:


:b. click 'X12 Options' again, 'Generate X12' then 'Validate and Clear' (no need to check the logs, you just fixed everything)
:c. click 'X12 Options'/ 'Generate X12'/ 'Continue'
::* to obtain the batch file (not pictured; is a simple file download dialog)
::* or to automatically upload it to clearinghouse if SFTP is configured.


= Step Two: Upload To Clearinghouse =
2. Click x12 options/ validate and clear (check the logs if desired)


This step varies widely depending on the clearinghouse. They all have similar functionalities because they're performing the same task but the mechanics differ significantly.* As mentioned, if an SFTP connection is being used, when the 'X12 Options/ Continue' button is clicked the transfer to the clearinghouse will happen automatically and a message to that effect will be displayed (not pictured).
3. Click x12 options/ continue - to obtain the batch file for upload to clearinghouse (not pictured; is a simple file download dialog)
* Otherwise, the claim files need to be uploaded manually, typically through a web portal of some sort.
* I (author HT) have worked with Trizetto, Availity and Office Ally. I personally found Office Ally to be the least versatile in the services they offer but also the least difficult to learn and to work with. The other two are much more full- featured services but their customer interaction interface is exceedingly complex, especially in interpreting response files.


--- or automatically upload it to clearinghouse if SFTP is configured.




= Step Three: Check For Response Files =
== EDI: Upload X12 Files To Clearinghouse ==
 
All clearinghouses will return some sort of response files to tell you the status of the claims in the uploaded batch file(s). But since their methods are so different from each other we won't get into any of them here; your billing or IT consultant will need to learn the idiosyncrasies.
* Generally, claim files will be rejected by the clearinghouse for incompatibility reasons, e.g., malformed x12 claim files (data missing or placed in the wrong fields).
* After it is accepted by the clearinghouse the claim file may be rejected by the payer for claim data problems, e.g., a patient's policy was not in effect on the Date Of Service.
* In either case you may correct the error and resubmit the claim.
** a. Go back to first section above, (step 1) and search on the corrected claim
** b. select it from the results (arrow at right below), click 'Re-open' (oval)
** c. include it in a future outgoing batch file
[[Image:bl11b.png]]
* Once the claim is accepted by the payer they will eventually send an ERA file with the payment


This step varies widely depending on the clearinghouse. They all have similar functionalities because they're performing the same task but the mechanics differ significantly.* As mentioned, if an SFTP connection is being used, when the 'X12 Options/ Continue' button is clicked the transfer to the clearinghouse will happen automatically and a message to that effect will be displayed (not pictured).
* Otherwise, the claim files need to be uploaded manually, typically through a web portal of some sort.
* I (author HT) have worked with Trizetto, Availity and Office Ally. I personally found Office Ally to be the least versatile in the services they offer but also the least difficult to learn and to work with. The other two are much more full- featured services but their customer interaction interface is exceedingly complex, especially in interpreting response files.




>>> On to the next page [[OpenEMR_6.x_Billing_-_Process_Payments]] <<<


= Conclusion =


NEXT section: [[Billing: Process Payments]]
That's it for the out- going claim data of the billing process. Next section we look at handling the incoming information- and hopefully money- from the submitted claims.

Revision as of 18:59, 2 August 2022

Introduction

OpenEMR's billing module is deep and complex; this document only shows the claims and invoice- related activities. Being as comprehensive as they are, the billing workflows depend on settings and data from other parts of the EMR in order to accurately fulfill their missions. Those requirements will not be detailed here, but they do need to be in place for claims to be successfully processed.

  • Be sure the Facility and Practice settings, Patient demographics and insurance information are correct

List_of_OpenEMR_Data_Fields_Required_For_Insurance_Claims

  • The encounter(s) to be billed must be complete; see

HOWTO:_Create_A_Claim-_Ready_Encounter

  • And, of course, the practice must have an account with a compatible clearinghouse


A few things to remember:

  • I am not an accountant or a billing professional! So I have borrowed terminology extensively from the billing documentation for older versions of OpenEMR . Particularly, Accounting_&_Receivables_4.1
  • If you have ANY billing questions go to the forum at https://community.open-emr.org/c/clinical-users/6 and ask the day-to-day users. Many forum readers have been using the OpenEMR billing module for many years and are happy to share their experience.
  • Also: most of the dropdown lists seen in this module may be customized. See other instructions in the wiki on using the List Editor.


The entire claim processing workflow can be arbitrarily divided into six major steps which I have placed into the following two wiki pages:

Page 1, Claims Creation - this wiki page

  • Generate Paper Claims
    • CMS 1500
    • Pt Invoicing
  • EDI: Generate X12 Claims In OpenEMR
  • EDI: Upload X12 Files To Clearinghouse


Page 2, OpenEMR_6.x_Billing_-_Process_Payments

  • Manual Payments
    • Search for Payments
    • Patient payments or EOBs
  • EDI: Claims Response Files
  • EDI: Apply ERAs


Please DM me on the forum if you have any questions about this documentation, or to point out any errors of fact I may have committed here!

  • HTuck - MI-Squared.com

Claims Creation

Claim creation is the same no matter what format they will be sent out as; x12 files, paper CMS1500 forms or postal- mailed invoices.

Having in place all the prerequisites mentioned above, the claims submission process all begins here: from the OpenEMR main menu, click 'Fees/ Billing Manager'; see the opening screen.

Note: unlike many OpenEMR functions, the Billing Manager may be operated without a patient record open.


Bl01.png



1. Search for the claims - the search criteria will open different types of smaller panels in which to specify the search terms:


  • All date criteria have date pickers
Bl02.png




  • The list- formatted data will show what has been configured in the EMR. See here the insurance company provided by 'Practice Settings/ Insurance Companies'
Bl03.png




  • Any simple text criteria will merely have a text input area (not pictured)

As they are input, the search terms are added to 'Current Criteria' (round rectangle)


Bl04.png





If you want to remove any terms from the Current Criteria, the yellow trash can deletes the selected one (here, Date of Service); the red can deletes them all.


Bl05.png







2. Click 'update list' to generate the list of claims

Bl06.png



Find the following lettered items in the picture below

a. look in the 'Expand' link to see the claim history (the display opens up, as Pepe's item shows)

Note: a red patient name (e.g., Pepe's) means something is wrong in insurance info... in this case his has no insurance company selected.

b. check that each claim has all the required elements:
  • 'Bill' Insurance and 'X12' entities are selected
  • the CPT4 or other service code (oval) given for the service(s) rendered in that encounter
  • the justifying ICD10 diagnosis code (rectangle) for each CPT code
  • the fee (arrow) for each CPT code
  • the rendering provider (yellow highlight) for each line item
  • Date of Service
c. each claim component may be edited from this claim listing** click on 'Encounter' (left blue button under name) to open the encounter summary form to fix things wrong with the encounter/ fee sheet
  • click on 'Patient' (right blue button next to insurance company name) for demographics or insurance company information errors
Bl07.png


d. you can reopen claims that have been marked as billed but not yet submitted


3. Click 'Clear Log' (oval below) before validating this batch of claims

Bl07-clearLog.png




Once the claims being processed have been validated and all necessary components verified, the claims may be sent out, either by electronic or paper media.


Generate Paper Claims

Once you have selected the claims to be submitted, proceed with which sort of claim will be generated: CMS 1500 claim forms or Patient invoices.

CMS 1500

  1. HCFA claims - Click the 'HCFA FORM' dropdown
  2. then select desired claim file format, .txt or .pdf

Bl08-claim-genHCFA.png





  • The file will be saved in the browser's designated local download location.
  • The data is laid out on the page to fit into the text areas on the form
  • It may be sent to a printer which has been loaded with the authorized pre- printed HCFA claim forms.


Bl08-claimHCFApdf.png

Patient Invoicing

Once all the payments from the insurance companies have been received and entered for an account, you can generate invoices from OpenEMR's EOB page to directly bill patients for the remaining amounts.


Note: any user with 'Accountant' or 'Administrator' ACL may generate invoices


1. Open the EOB page to generate invoices, at the main menu item: 'Fees/ Posting Payments'


Inv1-eob00.png





In the 'Invoice Search' section note radio button 'Invoice Search' (oval)

selected by default


Inv1-eob01.png

2. Search for invoices by:


  • Patient Name
  • Chart ID (PID or External ID)
  • Encounter number
  • Service date From/ To - get all invoices in that range
  • Type: see the list in picture
Inv1-eob02.png




3. Enter search criteria click 'Search' (blue button in previous pic)


4. See list of invoices matching the search


** remember: the ad-hoc simulated data pictured here do not accurately represent properly constructed claims **


The columns are self explanatory, except 'Prv' which older -version docs say 'indicates the number of insurance companies for which this invoice is awaiting payment.'


Inv1-eob03.png


5. Select the checkboxes (column 'Sel') of the invoices to be printed.


6. Per the button bar at the bottom:

  • 'Select all' - invoices displayed
  • Clear all - that have been selected
  • PDF Download Selected - print to pdf the selected invoices into the current user's Downloads directory from where they can be printed out for postal mailing.
  • Email Selected - to patient, if patient email notifications have been set up
  • Notify Patients Portal - what it says: send a message to the patients' portal account.


Inv1-eob05.png


Note: see the wiki page https://www.open-emr.org/wiki/index.php/Accounting_%26_Receivables_4.1#Patient_Invoices_and_Payments

for another description of this process.


Alternatively one may click on the invoice number (3d column in previous pic) to see its details, to make adjustments or whatever, then print the invoice for sending.


File:Inv1-eob04

EDI: Generate X12 Claims In OpenEMR

The electronic version of paper invoicing is, of course, generating and submitting x12 claim files to a clearinghouse.
Bl08.png


To continue from the Billing Manager workflow last pictured above in step 3 of first section, 'Claims Generation' in this page:


1. Instead of clicking 'HCFA Form', click 'X12 Options'

then:

'Generate X12'



Find the lettered items in the list below, in the following picture

Bl09.png


a. First: click x12 Options/ Validate Only








The X12 file displays.


b. Click 'Logs' button (oval lower right) to see if any problems have been registered in the claim validation logs.


Bl10.png






The validation log is another place to find what errors exist in the claim file that will prevent it from being accepted by the clearinghouse or insurance company.


The errors may be either corrected from the claim list and re- validated til clear of errors, or simply unselect the claims from the list. That claim will be excluded from the batch file but will re-appear next time a search is done that includes it.



Bl11.png


To finish the claim generation process:


2. Click x12 options/ validate and clear (check the logs if desired)

3. Click x12 options/ continue - to obtain the batch file for upload to clearinghouse (not pictured; is a simple file download dialog)

--- or automatically upload it to clearinghouse if SFTP is configured.


EDI: Upload X12 Files To Clearinghouse

This step varies widely depending on the clearinghouse. They all have similar functionalities because they're performing the same task but the mechanics differ significantly.* As mentioned, if an SFTP connection is being used, when the 'X12 Options/ Continue' button is clicked the transfer to the clearinghouse will happen automatically and a message to that effect will be displayed (not pictured).

  • Otherwise, the claim files need to be uploaded manually, typically through a web portal of some sort.
  • I (author HT) have worked with Trizetto, Availity and Office Ally. I personally found Office Ally to be the least versatile in the services they offer but also the least difficult to learn and to work with. The other two are much more full- featured services but their customer interaction interface is exceedingly complex, especially in interpreting response files.


>>> On to the next page OpenEMR_6.x_Billing_-_Process_Payments <<<

Conclusion

That's it for the out- going claim data of the billing process. Next section we look at handling the incoming information- and hopefully money- from the submitted claims.