Professional &Institutional ClaimsSoftware Built onSalesforce
Prepare, scrub, submit, and manage CMS-1500 and UB-04 claims directly in Salesforce.
A Salesforce-native revenue cycle management platform, not a bolt-on
Most billing systems sit beside your CRM and hand data back and forth through nightly files. Elixir is built on the Salesforce platform itself, so a patient, an encounter, a charge, a claim and a payment are all standard records governed by the same sharing rules, validation rules, reports and audit history.
Claims, charges, remittances and denials are native Salesforce objects your admins can extend without a vendor ticket- Works alongside Salesforce Health Cloud, Service Cloud and Experience Cloud patient portals
- Field history, Shield encryption and event monitoring apply to protected health information automatically
- Flows, approvals and Agentforce automation can act on billing data the day you turn them on
- One login, one permission model and one reporting layer across front office, clinical and revenue cycle teams
How a claim moves through Elixir
Six stages, each one a record state your team can report on and automate against.
- 01270 / 271
Verify
Coverage confirmed and benefits stored on the encounter. Copays, deductibles, and pre-authorization status populated in real-time.
- 02Encounters
Capture
Charges coded from the encounter with modifiers and units. Automated mapping between clinical notes and revenue items.
- 03NCCI Edits
Scrub
NCCI, payer and custom edits run before release. Strict checking prevents premature transmission of unbillable or conflict claims.
- 04837P / 837I
Submit
Claim batched and transmitted to the clearinghouse directly via integrated SFTP or REST APIs without manual file drops.
- 05999 / 277CA
Track
Acknowledgements and status posted to the claim. Instant notification of payer acceptance or clearinghouse-level rejection.
- 06835 ERA
Post
Remittance auto-posted, denials routed to worklists. Balances balance down to the line item; remaining amounts cascade to secondary.
98%+
First-pass clean claim rate
Targeted across Elixir healthcare clients and institutional facilities.
Up to 90%
Avoidable payer denials
Considered completely preventable industry-wide with native validation rules.
Nearly 60%
Raw claim error rate
Medical claims that contain structural or modifier errors before scrubbing.
Professional claims on CMS-1500 and institutional claims on UB-04, from one workspace
Billing teams rarely handle only one claim type. A health system bills facility charges on UB-04 while its employed physicians bill professional charges on CMS-1500 for the same encounter. Elixir prepares both from shared demographic, insurance and authorization data, then applies the edits that belong to each form.
CMS-1500 (02/12) • ANSI X12 837P
Professional claim preparation
CPT, HCPCS and ICD-10-CM capture: Built-in modifier validation (-25, -59, -78) and clinical diagnosis pointer logic (1-12 pointers).- Provider attribution & taxonomy: Place of service, rendering, billing, referring and supervising provider NPIs with taxonomy cross-checks.
- Drug administration: NDC, unit and dosage reporting for specialty pharmaceuticals administered in office.
- Fee schedules & pricing: Pricing by payer, contract and locality with automated allowed-amount variance flags.
- Specialty billing logic: Anesthesia time units, global period tracking and automatic split-billing rules.
UB-04 / CMS-1450 • ANSI X12 837I
Institutional claim preparation
- Revenue code pairing: Type of bill, revenue code to HCPCS pairing and units reconciliation across facility lines.
- Condition & occurrence tracking: Value, condition and occurrence codes with span dates validated against the stay.
- Inpatient & outpatient DRG: DRG assignment, present-on-admission (POA) indicators and patient discharge status.
- Facility provider attribution: Attending, operating and other operating provider reporting with taxonomy mapping.
- Claim frequency management: Interim, late-charge, replacement and void claim handling with correct frequency codes.
Automated claim scrubbing that stops denials before submission
Prevent uncollectible write-offs and back-and-forth payer requests. Elixir executes high-performance validation logic before claims ever reach clearinghouse queues.
CMS NCCI procedure-to-procedure & MUE
Identifies bundled service lines and excessive units of service (Medically Unlikely Edits) automatically based on CMS quarterly updates.
LCD/NCD medical necessity verification
Cross-checks diagnosis codes with procedure combinations to verify Local & National Coverage Determinations prior to release.
Payer-specific billing rules & dates checked
Applies custom timely filing limits, modifier requirements by commercial payer, and chronological service span dates.
Blocking edits vs. informational warnings
Hard stops prevent flawed transmission, while actionable alerts inform billers of opportunities for charge optimization.
AI claim rejection prediction that scores the claim before you send it
Rejection probability scoring: Machine learning models evaluate every line item against historical payer remittance behaviors.- Root-cause issue identification: Uncovers subtle mismatches that static rule engines miss, such as payer-specific policy idiosyncrasies.
- Prescriptive recommendations: Actionable recommendations written as plain instructions that any biller or coder can execute immediately.
- Granular line-item diagnostics: Flags the exact field, diagnosis pointer, or missing modifier causing the elevated risk score.
- Re-scored on demand: Corrected claims re-evaluate instantly within Salesforce so staff have confidence before final batching.
Claim rejection and EDI error resolution on the claim record itself
When a clearinghouse or payer rejects an EDI transaction, your team shouldn't have to decode cryptic ANSI X12 segments like STC*A3:23:40. Elixir translates clearinghouse responses directly into human-readable Salesforce fields.
277CA & 999 translation: Raw clearinghouse EDI response segments translated into clear English explanations directly in the claim view.
In-line field correction: Fix subscriber IDs, NPI numbers, or diagnosis codes right on the record without jumping between disparate systems.
One-click claim resubmission: Automatically generates clean replacement 837 transactions and queues them for the next transmission cycle.
ERA payment posting that reconciles the 835 to the penny
Manual remittance entry slows down cash flow and introduces human error. Elixir ingests 835 Electronic Remittance Advice files, automatically posting contractual adjustments, copays, coinsurance, and deductibles down to specific service line items.
Integrated clearinghouse connectivity for electronic claims submission
Connect seamlessly to national clearinghouses without managing local SFTP folders or brittle third-party sync utilities. Claims flow directly between Salesforce and payers with end-to-end encryption.
Full spectrum ANSI X12 transactions supported:
- 270 / 271 Eligibility
- 276 / 277 Claim Status
- 277CA Acknowledgement
- 999 / TA1 Functional Ack
- 837P Professional
- 837I Institutional
- 835 Remittance Advice
- 275 Additional Info / Attachments
What that means day to day:
- Automated batch scheduling sends claims at peak submission windows without staff intervention.
- Real-time clearinghouse status updates post back to Salesforce records within seconds of receipt.
- Clearinghouse portal logins become obsolete as all error resolution occurs within standard views.
Claim.MD
Live Out of the BoxDirect pre-configured API integration. Transmit claims, pull acknowledgements, and retrieve electronic remittances with zero custom middleware or SFTP maintenance.
Sub-second 270/271 real-time eligibility checks- Immediate 277CA status posting to Salesforce claim object
- Automated continuous 835 ERA delivery and reconciliation
Every other clearinghouse
Fully SupportedConnect to your existing clearinghouse contracts or internal EDI gateway using standard secure SFTP or REST protocols.
HIPAA compliant medical billing software for US healthcare providers
Built on Salesforce's enterprise-grade infrastructure, Elixir protects Protected Health Information (PHI) and meets the stringent compliance mandates expected by hospital compliance officers and chief information security officers.
BAA covered: Comprehensive Business Associate Agreements executed across all Salesforce and clearinghouse infrastructure.
Salesforce Shield encryption: PHI encrypted at rest and in transit using customer-managed keys (AES-256).
Role-based access control: Fine-grained field-level security, record sharing rules, and permission sets.
Immutable audit trails: Comprehensive Field History Tracking logs all changes to clinical and billing data.
HIPAA, SOC 1 Type II, SOC 2 Type II: Hosted on HIPAA-compliant, HITRUST CSF certified Salesforce cloud infrastructure.
Industry Tailored
Built for the organizations that bill both facility and provider charges
Hospitals and health systems
Coordinate UB-04 institutional charges for acute and outpatient stays alongside CMS-1500 claims for affiliated physician networks from a single Salesforce console.
Split-Billing Optimized
Physician groups and specialty practices
Manage high-volume CMS-1500 claims with automatic fee schedule lookups, complex surgical modifiers, and instant eligibility verification at front-desk check-in.
High-Volume Automation
Ambulatory surgery and behavioral health centers
Seamlessly handle ASC facility fees, per-diem behavioral health charges, and professional surgeon invoices generated during multi-specialty encounters.
ASC & RTC Ready
Billing companies and RCM outsourcers
Multi-client tenancy in a single Salesforce environment. Segregate payer rules, custom scrubs, and reporting dashboards across all contracted provider clients.
Multi-Client Scaling
See your own claims prepared in Salesforce
Bring a sample professional and institutional claim to a working session and we will walk it through scrubbing, submission and remittance on your payer mix.