ClaimYours reads your claims and remittances, catches what pays short or gets denied, and shows the exact rule behind every dollar — before you submit. Four rails, one platform, built for Ohio.
They post. They reconcile. They balance. And they leave your money on the table every single cycle.
A clearinghouse checks that a claim is valid — formatted right, codes present, not obviously rejectable. It passes. It pays. Everyone moves on.
But valid isn't correct. A claim can pass every format check and still pay below the rate you're owed, route to the wrong payer, or miss a modifier that quietly cuts the payment. Those don't bounce. They don't hit your denial queue. They just underpay you, cycle after cycle, and no tool you own is looking for them.
ClaimYours is the tool that looks — on every rail, against the actual published rules, before the claim ever leaves.
Each rail has its own rules. One engine that knows all four.
Multi-county service, one CODB rate, and no software that can tell the difference. We can — down to the county, the service, and the authorization behind it.
Provider status, coordination of benefits, telehealth modifiers — flagged before the claim leaves, not after the takeback lands months later.
Authorization scope, visit counts, TPA routing — checked against the referral before they cost you the payment and the filing window at once.
Plan-mix confusion and EVV enforcement turn clean claims into denials. One engine that knows which program governs each line and prices it right.
One rule engine, running every check that stands between a clean-looking claim and the money you're actually owed.
Every line priced against the verified published rate for its rail, county, and date.
Billed units checked against PAWS, referrals, and plan authorizations before submission.
Services subject to EVV matched to a visit record, so gaps get caught by you, not the payer.
Rendering provider active, credentialed, and affiliated on the date of service.
Coverage and primary-payer changes flagged before a claim routes wrong.
Telehealth and other modifiers flagged for human confirmation — never auto-applied.
Paid-vs-expected on every line, against Medicaid schedules and your contracted rates.
The filing clock tracked per claim, with alerts before the window closes.
Each correction cites the exact rule and effective date. Unverified rates are flagged, never guessed.
Three steps. You stay in control at every one.
Upload your remittances and claims, or connect your clearinghouse with delegated access. We read what flows through your EHR and clearinghouse — we don't replace either, and we never hold your credentials.
Every claim checked against the verified rule set for its rail. Underpayments, denials, and missed recoveries surfaced with the exact source behind each one.
Approve the corrections you want. We stage them; you submit through your own route. Nothing leaves without you, and every dollar traces to its rule.
You can act on a number that's traceable. You can't act on one that's plausible.
If a rate isn't verified against its published source, we don't show you a number. We show you the reason — and where the number would have been.
Where rate and plan complexity hides the most money — and where a spreadsheet stops keeping up.
An office manager can't catch rate-by-county variance at scale. The platform does the analysis; your team approves.
Even with an outside biller, the preventable denials happen upstream. We catch them before they reach the queue.
No, and that's deliberate. We read your files, find what pays wrong, and stage the corrections. You review and submit through your own clearinghouse or portal. We never hold your credentials or submit as you.
No. ClaimYours sits alongside your existing stack. We read the files that already flow between your EHR, clearinghouse, and payers — we don't replace them or ask you to re-key anything.
Every rate is verified against its primary source — the actual published rule or rate appendix. If a rate can't be verified, we flag it and show the reason instead of a number. We never guess.
Yes. HIPAA-aligned, hosted on AWS in the US, encrypted at rest and in transit, with a BAA available for every client and a full audit trail on every action.
Nothing. Send 12 months of remittances and we'll show you what you wrote off that was recoverable — with the rule behind each dollar. No pitch, no obligation.
Send us 12 months of remittances. We'll show you what you wrote off — no pitch, no cost, no obligation.
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