Claim #9
For Jane Doe on March 09, 2026
Claim Readiness
Required Claim Fields
- Service date 10 pts
- Duration (1-90 mins) 10 pts
- Diagnosis codes 10 pts
- Treatment notes 10 pts
Billing Identity
- Insurance name 5 pts
- Member number 5 pts
- Patient DOB 5 pts
- Practice NPI 5 pts
- Practice Tax ID 5 pts
Generated Artifacts
- HTML generated 10 pts
- PDF generated 10 pts
- Exports generated 5 pts
Claim Status
- Status appropriate 10 pts
Next Action
Generate claim documents (HTML/PDF)
Eligibility Checks
Last checked: No eligibility checks performed yet
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Document Status
Export for Submission
Generate submission-ready files to upload to your clearinghouse portal (Office Ally, Availity, etc.)
Complete Submission Bundle
Download everything you need for claim submission in one convenient ZIP file.
- CMS-1500 PDF for paper submission
- 837P EDI file for electronic submission
- Claim HTML & PDF documents
- README with submission instructions
Or export individual files:
CMS-1500 PDF
Standard billing form accepted by all insurance payers. Use for manual submission.
837P EDI File
Electronic X12 format for automated clearinghouse submission (5010 version).
Claim Status
Status History
-
EXPORTED
Exported 837P EDI file for electronic submission
Mar 09, 2026 09:46 PM -
EXPORTED
Exported CMS-1500 PDF for manual submission
Mar 09, 2026 09:46 PM
Patient Information
- Patient
- Jane Doe
- Date of Birth
- 1990-05-15
- Insurance
- Aetna - Member #AET123456789
Treatment Details
- Date of Service
- March 09, 2026
- Duration
- 30 minutes
- Conditions / Diagnoses
- Low back pain
- Treatments Performed
- Acupuncture
Created: 2026-03-09 21:05
Last updated: 2026-03-09 21:46