Medical practices
Independent physicians, physician groups, nurse practitioners, physician assistants
Professional Medical Claims Validation & Revenue Intelligence
Stop Denials Before They Start.
ClaimsRevenue™ helps healthcare providers validate professional claims before submission and analyze Electronic Remittance Advice (ERA) after payment, helping reduce denials, improve claim quality, and maximize reimbursement.
Reduce Denials. Increase Revenue.
Start SubscriptionYour practice earned the revenue. Protect it.
The industry math on denials is unforgiving. Every rejected claim is real dollars, real staff time, real delays in collecting revenue you already earned.
- 8%First-submission denial rate
- 44%of denials originate in front-end processes
- 84%classified as potentially avoidable
- $57.23estimated administrative cost to fight a denied claim
- $45,784illustrative annual denial-rework cost at 10,000 claims per year
Based on published MGMA, Optum, and Premier industry benchmarks. Individual practice results vary.
ClaimsRevenue™ helps move the work upstream, finding supported claim problems before submission instead of discovering them after a denial.
Catch it before you file it.
- Claims Validator™
Identify supported claim errors before submission.
- ERA Analyzer™
Turn payer responses into actionable revenue intelligence.
- Revenue Intelligence
See recurring problems, denials, expected revenue, and estimated revenue impact.
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Claims Validator™
Submit Cleaner Claims with Greater Confidence
Validate professional claims before submission with structured checks that help identify missing, inconsistent, or high-risk information before a claim leaves the practice.
- Prevent avoidable denials
- Improve first-pass acceptance
- Accelerate reimbursement
- Strengthen cash flow
- Reduce billing rework
- Minimize administrative burden
- Protect earned revenue
- Improve staff productivity
- Gain confidence before submission
- Spend more time with patients
See capabilities
- Guided CMS-1500 claim building
- Professional claim validation with clear passed, failed, warning, and not-evaluated states
- HIPAA 837P export for use with an existing clearinghouse
- Optional Claim.MD submission
ERA Analyzer™
Turn Remittance Data into Revenue Insight
Transform Electronic Remittance Advice into clear payment, adjustment, denial, and payer-performance insights so your practice can act faster and recover more of the revenue it has earned.
- Identify underpayments
- Understand denial patterns
- Accelerate payment reconciliation
- Improve revenue recovery
- Reduce manual ERA review
- Prioritize high-value follow-up
- Strengthen cash-flow visibility
- Track payer performance
- Protect earned reimbursement
- Reduce operational costs
See capabilities
- Analyze ERA/835 remittance information after payment
- Surface payments, adjustments, denials, trends, and potential reimbursement discrepancies
- Present clear summaries that help practices prioritize action
Built for Independent Providers and Practices
ClaimsRevenue™ is designed for independent professional healthcare providers and practices that submit professional claims and receive ERA files.
Behavioral health
Therapists, counselors, and behavioral health practices
Rehabilitation
Physical therapy, occupational therapy, and speech-language pathology
Other professional practices
Chiropractic and other independent professional healthcare practices
One connected revenue cycle
Cleaner claims before submission. Clearer payment intelligence after adjudication.
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Build or prepare the claim
Enter professional claim information through the guided workflow or prepare claim data for validation.
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Validate and correct
Review errors, warnings, passed checks, and items not evaluated before submission.
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Export or submit
Export a HIPAA 837P file for an existing clearinghouse or use optional Claim.MD submission.*
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Analyze the ERA
Review remittance results, payments, adjustments, denial patterns, and reimbursement insights after adjudication.
Works with your existing clearinghouse. Customers may validate and export HIPAA 837P files for use with platforms such as Change Healthcare/Optum, Office Ally, Availity, Waystar, TriZetto, and others. *Claim.MD submission is optional.
Security, Compliance, and Support
- HIPAA Compliant
Built and operated to align with HIPAA Privacy and Security requirements.
- Encrypted at rest
Application data is encrypted while stored on our infrastructure.
- Encrypted in transit
All connections use HTTPS with modern TLS.
- Live platform support
Monday–Friday, 9:00 AM – 8:00 PM Eastern Time.
Simple, transparent pricing
All plans include the same product features. Pricing scales with active rendering providers.
Solo
1 provider
$99 /mo
Start Subscription Most popular
Practice
2–10 providers
$249 /mo
Start Subscription Group
11–25 providers
$499 /mo
Start Subscription Scale
26–50 providers
$749 /mo
Start Subscription Premier
51–100 providers
$999 /mo
Start Subscription Optional add-ons
- Claim filing $30 / month
Unlimited claim submissions filed through integrated Claim.MD. Flat rate per TIN, no per-claim charges.
- Eligibility checks $0.02 / check
Real-time insurance eligibility verification via clearinghouse APIs. Pay only for what you use.
- AMA CPT® Royalty $0.65 / provider / year
Mandatory AMA royalty for use of CPT® content under the Provider Health Analytics Model license. Charged at provider-add and annually on your practice anniversary. Cost-recovery pass-through, no markup, non-refundable per AMA license terms.
- Payment processing 2.9% + $0.30 per invoice
Stripe's standard card processing fee, passed through at cost on each invoice.
Every plan includes
- Claims Validator™ with unlimited claim validations
- ERA Analyzer™ with unlimited ERA imports
- Guided CMS-1500 claim builder
- HIPAA 837P export for any clearinghouse
- Optional Claim.MD integration (add-on, per TIN)
- Multi-user access with role-based permissions
- Live platform support
- Plans are based on active rendering providers, not administrative staff.
- All prices in USD. Monthly billing only at launch.
- AMA CPT® Royalty rates are set by the American Medical Association and may be updated annually.
Frequently asked questions
Click a section to expand its questions.
Getting Started 8
What is ClaimsRevenue™?
ClaimsRevenue™ is a professional claims validation and revenue intelligence platform for U.S. healthcare professionals and practices. It helps users prepare and validate professional claims, analyze ERA data, and identify revenue-cycle trends.
Who can use ClaimsRevenue™?
ClaimsRevenue™ is a business-to-business platform for healthcare professionals and practices. It is not offered directly to patients or individual consumers.
What are the recommended technical requirements for using ClaimsRevenue™?
For the best experience, we recommend using the latest version of Google Chrome on a desktop or laptop computer with a reliable high-speed internet connection. ClaimsRevenue™ is a data-intensive application designed to display detailed professional claim information, validation results, ERA data, and revenue analytics.
While you may be able to access ClaimsRevenue™ from a phone or small-screen device, Claims Validator™ and ERA Analyzer™ are not designed for mobile use. These tools contain wide tables, numerous data elements, and detailed claim and remittance information that cannot be presented effectively on a small screen. For accurate review and efficient use of the platform, a desktop or laptop computer is strongly recommended.
How do I sign up for ClaimsRevenue™?
Create an account using your user information and the billing entity’s legal name, address, TIN, and Type 2 NPI, when applicable. Select your subscription plan and accept the required agreements. After the account is created, you can add providers, staff, and other practice information and complete any optional clearinghouse enrollment separately.
What information do I need to create a ClaimsRevenue™ account?
You will need basic account-user information and the billing entity’s legal name, business address, Tax Identification Number (TIN), and Type 2 NPI, when applicable. Clearinghouse information is not required during initial signup. After your account is created, you can add rendering providers (often using their individual NPIs), staff members, additional users, and other practice information.
Can I start using ClaimsRevenue™ immediately after I sign up?
Core ClaimsRevenue™ features can generally be used once your account setup is complete. Optional clearinghouse services require separate enrollment and approval before claims or other transactions can be submitted through the clearinghouse. Approval timing varies and may take from a short period to several business days.
Does ClaimsRevenue™ replace my EHR, EMR, or practice management system?
No. ClaimsRevenue™ is not an EHR, EMR, or practice management system. It is designed to supplement existing workflows with claim validation, professional-claim preparation, ERA analysis, and related revenue intelligence.
Can I manage more than one billing entity or TIN in ClaimsRevenue™?
Yes. A ClaimsRevenue™ account can support multiple billing entities and TINs. Each billing entity must be configured with its own legal business information, TIN, and applicable NPI information. If optional clearinghouse services are used, separate enrollment or approval may be required for each billing entity or TIN. A separate claim filing fee applies to each TIN that uses ClaimsRevenue™'s claim filing services.
Claims & ERA Tools 8
What does Claims Validator™ evaluate?
Claims Validator™ evaluates supported professional-claim rules and identifies results as passed, failed, warning, or not evaluated. It is designed to show what was checked and what still requires professional review.
Does a successful validation guarantee that a claim will be accepted or paid?
No. Validation can identify supported claim issues, but it cannot guarantee clearinghouse acceptance, payer acceptance, adjudication, coverage, reimbursement, or payment. Payer rules and claim outcomes depend on factors outside ClaimsRevenue™'s control.
Does Claims Validator™ check every payer rule?
No. ClaimsRevenue™ evaluates supported validation rules. Payer requirements, edits, policies, and coverage rules can change and may not all be available to or evaluated by the platform. Customers remain responsible for compliance with applicable payer requirements.
What does ERA Analyzer™ do?
ERA Analyzer™ organizes and analyzes ERA data to help practices understand payments, adjustments, denial patterns, payer performance, and revenue-cycle trends. Its outputs are informational and should be reviewed in the context of the practice's own records and payer information.
Does ClaimsRevenue™ provide coding, billing, reimbursement, legal, or compliance advice?
No. ClaimsRevenue™ provides software and platform support. It does not provide medical coding, billing, reimbursement, legal, tax, compliance, clinical, or payer-adjudication advice. Customers remain responsible for their claims and professional decisions.
Who is responsible for the accuracy of claim information?
The customer is responsible for the accuracy, completeness, authorization, coding, documentation, provider information, patient information, and other data submitted through ClaimsRevenue™.
Are claim validations and ERA imports limited?
Current subscription plans include unlimited use of Claims Validator™ and unlimited ERA imports, subject to the Terms, applicable plan features, and reasonable-use and technical limitations.
What types of claims does ClaimsRevenue™ support?
ClaimsRevenue™ currently supports professional claims, including CMS-1500 claims and HIPAA 837P transactions. Institutional claims, such as UB-04/837I claims, and dental claims are not currently supported.
Clearinghouse & Eligibility 4
Does ClaimsRevenue™ replace my clearinghouse?
Not necessarily. ClaimsRevenue™ can export HIPAA 837P files for use with compatible healthcare clearinghouses. Optional integrated clearinghouse services may also be available for eligible customers.
How do optional clearinghouse services work?
Clearinghouse connectivity requires enrollment and approval before transactions can be submitted. Timing varies based on the clearinghouse, payer, provider, TIN, NPI, and other enrollment requirements. ClaimsRevenue™ does not guarantee approval or activation by any particular date.
Can I use my existing clearinghouse?
Yes, if your clearinghouse can accept the HIPAA 837P file generated by ClaimsRevenue™. Compatibility, enrollment requirements, payer connectivity, and submission rules are determined by the applicable clearinghouse and payer.
Does ClaimsRevenue™ support eligibility checks?
Optional eligibility inquiries may be available through an integrated clearinghouse. Eligibility responses may be limited or incomplete and do not guarantee coverage, benefits, authorization, medical necessity, or payment. Providers remain responsible for verifying coverage when additional confirmation is needed.
Pricing & Billing 8
How are providers counted for subscription pricing?
Subscription tiers are based on the number of rendering providers whose services appear on claims. Administrative users are not counted as rendering providers solely because they have platform access.
Are there separate licensed-content fees?
Certain users or functions may require access to third-party licensed healthcare content. When applicable, a separate annual licensed-content fee will be disclosed before it is charged. Once charged, that fee is non-refundable except where required by law.
How does subscription billing and cancellation work?
ClaimsRevenue™ subscriptions are billed monthly and automatically renew each month until canceled. You may cancel at any time; cancellation takes effect at the end of the then-current paid billing period. Fees already charged are non-refundable except where required by law. Current pricing and applicable add-on charges are presented before purchase.
How are eligibility checks billed?
Eligibility checks run through the integrated Claim.MD clearinghouse are counted throughout the month and billed at $0.02 per check on the 1st of the following month. The itemized charge appears on your Stripe invoice. Only successful checks are billed; network errors and payer rejections are excluded.
What happens if my subscription payment does not go through?
If your monthly subscription payment is unsuccessful, we will notify you and give you an opportunity to update your payment method. If payment has not been received by the fourth business day after the first day of the month, your ClaimsRevenue™ account will be placed on hold. Once the outstanding subscription balance is paid and a valid payment method is on file, access to your account will be restored.
Is there a free trial?
No. ClaimsRevenue™ is a paid professional platform designed for active healthcare practices and does not currently offer a free trial.
What happens to my subscription when I add or remove providers?
ClaimsRevenue™ pricing is based on provider tiers. You may add or remove rendering providers as long as your total provider count remains within your current plan’s range without changing tiers. If adding a provider moves your practice into a higher-priced tier, the applicable additional subscription charge will be prorated for the remainder of the current billing period. If removing a provider qualifies your practice for a lower-priced tier, the lower rate will take effect on your next subscription payment date.
What happens to my account when I cancel my subscription?
Cancellation takes effect at the end of your current paid subscription period. Once the subscription ends, you will no longer have access to your ClaimsRevenue™ account or the information available through the platform. You should download or retain any information your practice needs before your access ends. ClaimsRevenue™ may continue to retain information as described in its Privacy Policy, Business Associate Agreement, and applicable records-retention requirements.
Security & HIPAA 8
Do I need to sign a Business Associate Agreement (BAA)?
Yes. As part of the electronic signup process, authorized practice representatives agree to the ClaimsRevenue™ Business Associate Agreement and other applicable terms. ClaimsRevenue™ records the electronic acceptance, and the completed BAA remains available for future reference.
Is ClaimsRevenue™ HIPAA compliant?
ClaimsRevenue™ is designed to support healthcare customers in workflows involving protected health information and enters into a Business Associate Agreement with covered customers. Customers remain responsible for their own HIPAA obligations and for using the platform in accordance with the BAA and Terms.
For more information, customers can review the U.S. Department of Health and Human Services HIPAA overview, which explains the Privacy, Security, and Breach Notification Rules.
How does ClaimsRevenue™ protect sensitive information?
ClaimsRevenue™ maintains administrative, physical, and technical safeguards designed to protect protected health information and other sensitive data, including access controls, authentication, encryption, audit controls, and backup protections as appropriate to the service.
Does ClaimsRevenue™ use patient or claim data to train AI models?
No. ClaimsRevenue™ does not use identifiable patient or claim information to train AI models. Product and business-intelligence development may use information that has been de-identified in accordance with applicable requirements.
Does ClaimsRevenue™ sell customer or patient data?
No. ClaimsRevenue™ does not sell customer data or protected health information. Information may be disclosed to service providers and other parties only as permitted by the Terms, Privacy Policy, Business Associate Agreement, or applicable law.
How long does ClaimsRevenue™ retain claim and ERA data?
ClaimsRevenue™ generally retains applicable practice, claim, and ERA records for seven years under its records-retention policy, subject to legal, regulatory, contractual, backup, and legal-hold requirements. Account cancellation does not necessarily result in immediate deletion of retained records due to legal requirements.
Can multiple staff members share the same ClaimsRevenue™ login?
No. Login credentials may not be shared. Each authorized user must have an individual ClaimsRevenue™ account and use their own login credentials and two-factor authentication. Individual accounts help protect sensitive information, maintain appropriate access controls, and ensure that system activity can be attributed to the correct user.
Can ClaimsRevenue™ be used for records subject to 42 C.F.R. Part 2?
Not at this time unless MoodRx LLC expressly authorizes that use in writing. 42 C.F.R. Part 2 is a federal confidentiality law that provides additional protections for certain substance use disorder treatment records. Customers are responsible for determining whether they are a Part 2 program or whether information they intend to submit is subject to Part 2. If you are unsure, contact legal@claimsrevenue.com before submitting the information.
For more information, customers can review the U.S. Department of Health and Human Services overview of 42 C.F.R. Part 2, which explains the confidentiality protections for substance use disorder patient records. The full current regulation is also available in the federal Electronic Code of Federal Regulations, 42 C.F.R. Part 2.
Account & Support 6
Who should create the ClaimsRevenue™ account for my practice?
The account should be created by, or with the authorization of, someone who has authority to act on behalf of the practice, such as the practice owner, practice manager, or another authorized administrator. That person must have authority to accept the ClaimsRevenue™ Terms, Privacy Policy, Business Associate Agreement, and applicable billing terms on behalf of the practice.
What is two-factor authentication (2FA), and how does it work?
Two-factor authentication, or 2FA, adds an extra layer of security to your ClaimsRevenue™ account. In addition to your password, you must provide a one-time verification code when prompted. ClaimsRevenue™ supports verification through an authenticator app or by email. This helps protect your account even if your password is compromised. For security, each user should use their own login credentials and should never share verification codes with anyone.
I signed for a pricing tier but my practice is growing. How do I add more providers?
Once you login, within the settings menu, you can upgrade your subscription to the right size at anytime.
What support is available?
Live platform support is available during published support hours for platform questions and technical issues. Support does not include medical coding, billing, reimbursement, legal, tax, compliance, clinical, or payer-adjudication advice.
Should my practice have more than one account administrator?
Yes. We strongly recommend assigning at least one backup administrator when your practice is set up. The backup administrator can remain inactive when not needed but can help maintain access if the primary administrator leaves the practice or becomes unavailable.
What if our account administrator leaves and we do not have a backup administrator?
ClaimsRevenue™ must verify authority before transferring administrative control of an account. If no authorized administrator is available, we may require documentation establishing your identity, authority, and relationship to the practice. Depending on the circumstances, this may include business formation documents, a notarized ownership statement, business insurance documentation, a professional license, or other appropriate records. ClaimsRevenue™ may request additional documentation when necessary to protect the practice and its information.
Submit Cleaner Claims. Understand Every Payment.
Bring pre-submission validation and post-payment revenue intelligence into one focused workflow for your practice.
Start Subscription