Paid below your contract
The payer paid less than the rate your contract says for that service on that date. You see billed, correct, the difference and the contract line it came from.
Wrong rate for the place
The rate billed belongs to a different county, region or setting than the one served. For Ohio DODD this is the county rate cell.
Units over the authorization
More units were billed than the authorization on file allows, or no authorization exists. The claim waits while the ask goes out.
No visit on record
A service that needs visit verification has no matching visit, or the visit logged fewer units than the claim.
Lapsed credential
The staff member’s certification was not current on the date of service. The claim is re-checked when the answer comes back.
Duplicate line
A line repeats a claim already billed or paid. Flagged before it goes out.
Filing clock running down
The window to file or correct the claim is closing. Early warning per claim.
Denied, with a fixable reason
The denial maps to a correction we can write, or to an appeal the record supports. Drafted for your approval.
Paid, but unexplained
The amount paid matches no contract line, rate table or payment history we can point to. Labelled unexplained, never guessed.
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.
Three problems every billing office knows
Claims sit denied for weeks
A denial shows up days after you submit, then waits in a queue until someone has time to work out why.
Nobody knows which rule failed
A denial code tells you something is wrong. It rarely tells you which rule, or what to change.
Adjustments never get filed
Short pays and underbilling are easy to miss, and easy to put off until the window closes.
Made around the systems Ohio providers actually use
Each rail runs on its own rules, files and agencies, not a generic national rulebook.
Ohio DODD
Waiver claims checked against the service rules in OAC Chapter 5123-9, with corrected files staged for eMBS.
County boards & PAWS
All 88 Ohio counties mapped to their rate categories, and units checked against the PAWS authorization on file.
ODM behavioral health
The ODM Behavioral Health Provider Manual and the Ohio Medicaid BH fee schedule (OAC 5160-27-03), checked before an MCO sees the claim.
Home care programs
PASSPORT, MyCare Ohio and the Ohio Home Care Waiver, matched to your Sandata or HHAeXchange visit records.
VA Community Care
Every claim matched to its HSRM referral and paid against your Community Care Network agreement.
Your payer contracts
For any other practice, each paid line is compared with your contract rate or what that payer has really paid you.
Patient data stays inside the platform
From sign-up to your first checked claim
Sign up
Create an account, or start with the demo to see the platform first.
Approved
A person at ClaimYours AI reviews and approves your account.
BAA accepted
Your practice accepts the Business Associate Agreement inside the platform.
Upload & check
Upload claims inside your account and see every result with its source.
See how every claim gets checked.
Try the demo yourself, or ask for a walkthrough. No patient information needed.