US Billing · Billing integration
Bill US payers with real EDI, not a spreadsheet export.
US insurance billing runs on the X12 standard, and doing it properly means more than generating claims: it means reading the acknowledgment, posting the electronic remittance, and checking eligibility before the visit. Clinicmaster does all four through a clearinghouse.
The US billing integration
US professional medical billing uses the ASC X12 transaction set: an 837P to submit a claim, a 277CA to acknowledge it, an 835 to remit payment, and a 270 to check eligibility. Clinicmaster generates and consumes all four through a clearinghouse, submitting and retrieving over a secure file channel and checking eligibility over an API — so a US clinic runs its revenue cycle inside the same system as its clinical work.
What the US billing integration does.
Anyone can produce a claim file. The revenue-cycle work is in the three transactions that come after it.
837P professional claims
Claims are generated in the X12 837P format from the billable items recorded against visits, and submitted to the clearinghouse — not exported for someone to rekey.
277CA acknowledgments processed
Claim acknowledgments are retrieved and processed automatically, so a claim rejected at the clearinghouse is visible immediately rather than discovered when payment never arrives.
835 remittance posted
Electronic remittance advice is downloaded and the payments post against the invoices they pay, through the standard accounting path.
270 eligibility enquiries
Eligibility can be checked over an API before the visit, which is the cheapest possible moment to discover a coverage problem.
Secure transport
Claim submission and file retrieval run over an encrypted file-transfer channel with per-clinic credentials held server-side.
Runs in the background
Acknowledgment and remittance processing run as scheduled background jobs, so the cycle keeps turning without anyone driving it.
The full EDI cycle, in one system.
Eligibility is checked up front.
A 270 enquiry confirms coverage before the visit, so a claim is not built on a plan that will not pay it.
837P claims go to the clearinghouse.
Claims are generated from the recorded billable items and submitted over a secure file channel, then acknowledged back via 277CA.
835 remittance settles the invoices.
Electronic remittance is downloaded and the payments post to the right invoices automatically, closing the cycle.
What this integration does not do
Claims reach payers through a clearinghouse, not by direct payer-by-payer connections — that is normal for US professional billing and it is what makes one integration cover many payers. Submission and remittance are file-based on the clearinghouse cycle, not real-time adjudication. Payer contracts, fee schedules, credentialing and clearinghouse enrolment are arranged by your clinic.
What Clinicmaster generates and consumes.
Each transaction below is a real X12 exchange handled in the system, which is what distinguishes an EDI integration from a claim-file export.
Back to regional billing- 837P professional claim
- 277CA claim acknowledgment
- 835 electronic remittance
- 270 eligibility enquiry
- Clearinghouse submission
- Secure file transfer
- Automated payment posting
- Per-clinic directories
- Scheduled background processing
US billing questions.
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