Billing and claims
Electronic claims
Enroll with payers, submit scrubbed claims electronically, read claim status (276/277), correct and resubmit rejections in one click, and handle secondary claims.
Sefton submits claims electronically through our clearinghouse. The payer list is the live clearinghouse directory, so a payer you can pick is a payer you can reach.
Enrollment
Billing > Enrollment lists your payers and whether claims, remittance (ERA), and eligibility are enabled for each. Payers that need an EDI agreement show the steps and status. Turn on ERA everywhere you can; it is what makes payment posting automatic.
Submitting
A claim in Ready to send has passed the scrubber (payer rules, code and modifier validation, eligibility on the date of service, authorization units). Submit sends it; the claim moves to Awaiting payer. Voice works here too: “Submit the claim for today’s visit.”
Claim status
Claims Status refreshes acknowledgement and adjudication status from the clearinghouse (Refresh All or Check Now on one claim). Search by 276 runs a summary or detail status inquiry by payer ID, NPI, dates, and member. Payment information appears when the payer reports it.
Rejections and corrections
A clearinghouse or payer rejection puts the claim in Needs correction with the reason in plain language and the field highlighted. Fix it and click Resubmit corrected claim; Sefton sets the frequency code and references the original.
Secondary claims
When the primary remittance posts and a secondary payer is on file, Generate secondary builds the secondary claim with the primary’s adjudication attached. Skipped or errored secondaries are listed so nothing is lost.
Attachments
Evaluation reports, progress reports, and plan-of-care documents attach to the claim and travel with it where the payer accepts attachments (Evaluations and reports).
Frequently asked questions
How long does payer enrollment take?
Most commercial payers accept claims immediately through the clearinghouse. Medicare, Medicaid, and some Blues require an enrollment (EDI agreement) that can take one to four weeks; the Enrollment page tracks each payer.
Are there per-claim fees?
No. Unlimited claims are included in Sefton Complete.