Billing and claims
Billing overview
The Billing workspace: the claim lifecycle from Needs correction to Paid, the authorizations, receivables, and remittance tabs, and the work queues that tell you what is blocking revenue.
Billing (the Billing tab; the route is /revenue) is organized around the life of a claim, not around reports.
The lifecycle
Every claim sits in one phase:
- Needs correction: the scrubber or a payer rejection found something fixable. Open it, fix, and it moves on.
- Ready to send: scrubbed clean, waiting for you to submit (or for co-sign).
- Awaiting payer: submitted; status updates arrive from the clearinghouse.
- Paid: remittance posted.
- Follow-up needed: denied, partially paid, or silent past the expected turnaround.
Tabs
- Claims: the lifecycle above, with guided correction for blocked claims.
- Authorizations: prior authorizations and their unit budgets (Prior authorizations).
- Receivables: AR aging by payer and by patient, statements, and patient payments.
- Remittance: ERA files and payment posting (Remittance and payment posting).
Work queues
The queues count what is blocked: claims needing correction, notes awaiting co-sign, denials with an appeal deadline, authorizations about to run out, unmatched payments. “No blocked revenue queues” is the goal state.
Links from Billing
Rates, Payer participation, Credentialing, Prior auth records, Referral records, Network intelligence, Documentation completeness, Time tracking, Co-sign queue, and Session goal tracker are one click away from the workspace header.
Core versus Complete
On Sefton Core the workspace produces superbills, CMS-1500s, statements, and Good Faith Estimates. On Sefton Complete the same claims go to payers electronically and come back as status and remittance. See Choose your plan.
Frequently asked questions
Do I need a billing service?
No. Sefton is the billing workflow: scrubbing, submission, status, remittance, denials, and appeals, with no per-claim fee and no revenue share on Sefton Complete.