10decodersOne queue, not six payer portals.
A multi-specialty medical center submitted claims through six separate payer portals, discovered denials after the fact, and had no record of who changed what on a claim. 10decoders deployed Claims360 — one submission interface across every payer, scrubbing that catches errors before they leave the building, and an audit trail on every field.
Six portals, five departments, no single view.
The medical center's revenue cycle ran across disconnected systems. Each payer had its own portal and its own submission rules, so a claim was entered wherever it needed to go and tracked in whatever the billing team could improvise. Denials surfaced weeks later with no way to tell whether the cause was a coding mismatch, an eligibility gap or a payer-specific field — and no way to see whether the same cause was repeating in one department. Changes to a claim left no record: no user, no timestamp, no before-and-after. Disputes were argued from memory.
10decoders built Claims360 to make the revenue cycle observable. Every payer network and every clinical department sits behind one interface. Claims are validated against payer-specific rules before submission — code coverage, eligibility, duplicates, encounter date windows, payer ID matching — so preventable errors are caught while they are still cheap to fix. Valid claims group into batches by payer for confirmation and submission. Denial analytics break down by department and payer combination, and every change to every claim is written to an immutable log.
From reactive denial chasing to prevention at submission.
The challenge
- Claims submitted manually through six separate payer portals, each with its own rules
- No pre-submission validation, so preventable errors reached the payer before anyone saw them
- Denials analysed case by case, with no view of which department and payer pairings repeated
- Claim status and field changes untracked — no user, no timestamp, no before-and-after values
- Compliance reporting assembled by hand, leaving disputes slow and evidence-poor
Our approach
- All six payer networks behind one submission interface, with routing handled automatically
- Automated scrubbing against payer-specific rules before a claim leaves the system
- Batch grouping by payer with value confirmation, replacing per-portal submission work
- Denial analytics broken down by department and payer, so causes are visible at the source
- An immutable audit trail capturing user, timestamp and old-to-new values on every change
Built to catch errors before the payer does.
A denial found at scrubbing costs a correction. The same denial found at adjudication costs an appeal.
Multi-payer submission
Claims are entered once and routed to the right payer network automatically, removing duplicate entry and per-portal context switching.
Pre-submission scrubbing
Code coverage, patient eligibility, duplicate detection, encounter date windows and payer ID matching are checked before a claim is sent.
Batch creation & submission
Scrubbed claims group by payer into review-ready batches, with total value and payer breakdown confirmed before a single submission action.
Department denial analytics
Denial rates, approval percentages and processing times break down by clinical department and payer combination, so intervention targets the source.
Real-time claims dashboard
Bill counts by status, submission trends and payer-level approval rates update automatically, so the current state is known without running a report.
Immutable audit trail
Status updates, field edits and payer ID corrections are logged with the user, timestamp and old-to-new values, and cannot be altered after the fact.
Four capabilities. One platform.
Claims360 covers the path from the first claim entry through to the audit record that defends it.
Claims management application
Claim submission, payer tracking, status management and patient billing across every network from a single browser-based interface, with role-scoped views for billing staff and finance leadership.
Automated scrubbing engine
Pre-submission validation against payer-specific rules — code coverage, eligibility confirmation, duplicate detection, encounter date windows and payer ID matching — blocking errors before a claim reaches the payer.
Batch submission system
Claim grouping by payer with total value confirmation and a two-step submission flow, with batch records and submission confirmations retained for compliance reference.
Analytics & immutable audit trail
Denial rates, approval percentages and processing times by department and payer, backed by a tamper-proof log capturing every claim change with user identity, timestamp and before/after field values.
From claim entry to a defended submission.
Four steps take a claim from entry through validation, batching and the record that backs it.
Enter the claim once
Claims are entered in a single interface and routed to the correct payer network automatically, with no per-portal duplication.
Scrub before sending
Payer-specific rules validate codes, eligibility, duplicates and date windows, surfacing errors while they are still correctable.
Batch & submit
Valid claims group by payer into a review-ready batch, with value and breakdown confirmed before submission.
Track & analyse
Status, denial patterns and the full change log stay visible by department and payer for follow-up and dispute.
What each team actually sees.
Role-scoped views and permissions — billing works the submission queue, while finance and compliance watch the trend and the trail.
Submission, scrubbing and batching
- A full claims list filtered by payer, status and department, searchable by claim identifier
- One-click scrubbing that validates codes, eligibility and payer IDs before anything is sent
- Batch creation by payer with value and breakdown review, then a single confirmation to submit
- A status board of valid, invalid and pending claims that stays current without a manual refresh
Denial trends and the audit record
- Denial rates across every clinical department, with payer-level breakdown inside each one
- Submission volume and approval trajectory over time, across all payer networks
- The full immutable trail — every status change, field edit and payer update, exportable for disputes
- Drill-down into any payer or department to identify a denial root cause before it repeats
A revenue cycle you can see, and defend.
What changed for each group — and the controls the platform is built on.
One workflow, every payer
Staff work a single queue instead of six portals — scrubbing, batching and submitting from one place, with the most common preventable errors caught before a claim leaves the system.
Denial causes made visible
Denial patterns break down by department and payer combination rather than arriving as a monthly total, so process changes land where the denials actually originate.
Evidence-backed disputes
Every claim change is logged immutably with user, timestamp and before/after values in an access-controlled environment. Source code and IP ownership remain with the client throughout.
