Claim import
Parse 837I, FHIR, JSON, XML and UB-04 claims, regroup the MS-DRG and check it against the billed DRG.
Intake
Claim files
Up to 4 MB per file and 50 files per worklist. Each file is read in your browser. Names, member and subscriber IDs, birth dates (kept as an age), addresses, phones and emails, SSNs, record and policy numbers, free-text notes and dates of death are taken out, and claim numbers become tokens, before it is sent once to the parser; nothing is saved, put in links or kept in browser storage. A PDF cannot be cleaned here, so use a test or de-identified one.
Or paste a claim
Options
Blank uses the CCN on each claim. A hospital is needed to price; grouping doesn't need one.
Picks the MS-DRG manual (grouper version). Blank uses the date on each claim.
Worklist
| # | File | Claim | Billed | Regrouped | Agrees | Payment | Status | Remove |
|---|
Claim detail
Findings
Actions
Reference
Free tier
Parsing, MS-DRG regrouping and DRG validation are free. Pricing inside an import counts toward the 40 priced claims a day without signing in, and covers a set of common MS-DRGs; other DRGs still group and validate, with a note in place of the price.
Formats this reads
- 837I (X12 5010 institutional)
- Bill type, diagnoses with POA, procedures, the billed DRG (HI DR), discharge status, dates, charges and SV2 service lines.
- FHIR R4 Claim (JSON or XML)
- Diagnoses, procedures, billing period and total. FHIR carries no discharge status or age, so add them before relying on transfer or age logic.
- JSON or XML claim
- A flat claim with diagnoses, procedures, age, sex, discharge status and DRG. Unrecognized XML is swept for code shapes and marked for review.
- UB-04 PDF
- Text-layer PDFs only (no scans). Codes are pattern-matched and always marked for review: confirm order, POA and the principal diagnosis.
Remittance
835 remittance
The claims it pays
Matched by claim ID: CLP01 on the 835 to CLM01 on the claim. Up to 4 MB per file. Files are read in your browser and sent once; nothing is saved. Use test or de-identified files.
Options
Blank uses the CCN on each claim.
Recoverable means
Each matched inpatient or outpatient claim counts as one priced claim.
Paid against expected
Reconciliation
| Claim | DRG paid / expected | Paid | Allowed as paid | Expected | Variance | Recoverable | CARC / RARC | Likely cause |
|---|---|---|---|---|---|---|---|---|
| Choose an 835 and the claims it pays, then press Reconcile. | ||||||||
How it compares
Allowed, not the cheque
Expected is Original Medicare's payment for the claim: the regrouped MS-DRG priced at the hospital with the claim's own stay, charges and discharge status, or the outpatient lines priced under OPPS. It is before the patient's share and before sequestration, so the payer side is rebuilt the same way: paid plus patient responsibility plus CO-253. Variance is that less expected; positive is an overpayment.
Likely causes
- DRG mismatch
- The DRG on the remittance (CLP11) is not the one the claim regroups to.
- Outlier
- The payer's outlier (MIA02) differs from the expected cost outlier, or the shortfall equals it.
- Transfer
- The discharge status makes the stay a transfer and the payment matches the full DRG instead of the per diem.
- Sequestration
- A 2% shortfall with no CO-253 on the remittance.
- Contractual
- CO-45 took the allowed amount below the expected rate, with nothing else to explain it.
- Denied
- Nothing paid; the CARC says why.
Free tier
Up to 10 priced claims per reconciliation and 40 a day without signing in, on the common MS-DRGs. Other DRGs, professional claims and unmatched claims are listed with their payment and codes, unpriced.