Submit your first claim, end-to-end
From visit close to ERA posting — every step in order with the gotchas called out.
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A clean claim, paid the first time
Scrub before you submit, watch the status flip, and let the ERA auto-post itself
This walks the path: superbill → claim draft → scrub → submit → ERA. Do it once on a friendly test patient before going live, and you'll know exactly where every status badge will sit on the day a real one matters.
Capture the superbill
On a signed note, the diagnosis and CPT codes auto-flow into a superbill. Verify modifiers, units, and place-of-service. The most common mismatches we see — and the ones the payer will reject without ever paying you — are: a telehealth code (90837, 99213, etc.) sent without modifier 95, an in-person POS 11 paired with a telehealth code, units that don't match the time documented in the note. Five seconds of verification here saves a denial cycle later.
Run the scrubber
Missing modifier on 90837
Telehealth visit needs modifier 95.
POS / CPT mismatch
POS 11 with telehealth code - payer will reject
Eligibility older than 24h
Re-run before submission for fresher response
Billing → Claims → New → Scrub. The scrubber catches missing modifiers, mismatched POS-CPT, eligibility gaps, and prior-auth requirements before the claim leaves your building. Red items block submission — you cannot send the claim until they're fixed; the Submit button stays disabled with a tooltip explaining why. Yellow warnings are non-blocking but worth a glance (e.g. eligibility older than 24 hours, a payer-specific quirk that's caused denials in the past). Fix every red, decide on every yellow, then move on.
Submit and acknowledge
Tap Submit. The claim goes to your clearinghouse within 60 seconds and the status badge flips to Sent. The next status — Acknowledged — comes back from the payer once they've accepted the file format and patient match (usually under 24 hours; some Medicaid plans take 2–3 business days). If a claim sits in Sent for more than 48 hours without acknowledgement, open it; the clearinghouse rejection (if any) is shown inline with the original submission for easy editing.
When the ERA arrives
Submitted
T+0Sent to clearinghouse
Acknowledged
T+19hPayer accepted intake
Paid · ERA posted
T+12dAuto-posted in 47s · $124.18
Patient invoice
T+12dBalance $30 - auto-emailed
Days later (typically 7–14 for commercial plans, longer for Medicaid), the payer sends back an Electronic Remittance Advice. EnWella pulls the ERA from the clearinghouse, matches it to your submitted claim by trace number, and auto-posts payments and adjustments within 60 seconds — no manual matching, no spreadsheet. Anything we couldn't auto-match (mismatched amount, missing claim, take-back) lands in the Unposted queue for one-click review. Patient responsibility flips into an invoice the moment the ERA posts; we email the patient automatically and the balance shows on their portal.
When a denial comes back instead
Not every claim pays. Denials land in Billing → Denials, grouped by reason code so you can fix one CO-50 (medical necessity) and bulk-fix the other twelve in the same group. Each denial keeps the full payer message, the original claim, and a one-click Start appeal that pre-fills the appeal letter with patient demographics, claim history, and the denial language. The deeper playbook lives in the Handling denials article.