CV
ClaimsVerify
A
User
Upload EDI Files
Upload your X12 837 claims file and 835 remittance ERA file to reconcile.
837 Claims File
X12 Professional or Institutional
835 Remittance File
X12 ERA - .txt .edi .835
Reconciliation Results
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Total Claims
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Matched
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Partial / Adjusted
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Denied / Unmatched
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Payment Match Rate
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| Claim ID | Patient | Payer | DOS | Billed | Paid | Variance | Status |
|---|
Submission Summary
Overview of payment distribution and top adjustment codes.
Payment Distribution
File Metadata
Top Adjustment Reason Codes (CARC)
How ClaimsVerify Works
A step-by-step guide to the reconciliation process, EDI parsing, and system features.
🔗
Step 1 - Login
Sign in with your unique credentials. Each user has their own isolated session.
⇧
Step 2 - Upload
Upload your X12 837 claims file and 835 remittance ERA file.
▶
Step 3 - Reconcile
The system parses both files and matches claims by Claim ID automatically.
↓
Step 4 - Export
Download a full Excel report or CSV with results, denials, and recommended actions.
🔗 Login & Session Isolation
Each user signs in with a unique username and password. Sessions are completely isolated - no user can see another user's uploaded files or reconciliation results. When you log out, your screen clears. When you log back in, your previous session is restored.
AdminFull access + User Mgmt + Subscriptions
ManagerUpload, reconcile, view, export
BillingUpload, reconcile, view, export
AuditorUpload, reconcile, view, export
⇧ File Upload
Upload two X12 EDI files. The system auto-detects element separators, component separators, and segment terminators from the ISA envelope - no configuration needed.
837 FileClaims sent to payer - what was billed
835 FileERA from payer - what was paid
837PProfessional claims supported
837IInstitutional claims supported
VersionX12 005010 EDI standard
📋 EDI Segments Parsed
FROM 837
CLMClaim ID & billed amount
NM1*ILPatient name
DTP*472/434/435Date of service
FROM 835
CLPClaim ID, status, billed, paid
NM1*QCPatient name
SVCService line - procedure, billed, paid
CASAdjustment reason codes (CARC)
DTM*232/472Date of service (claim & line level)
N1*PRPayer name
▶ Reconciliation Logic
Claims from the 835 are matched to the 837 using the Claim ID as the key. Each matched claim is assigned a status based on the CLP02 status code and the billed vs paid variance.
MatchedPaid = Billed (variance < $0.01)
PartialPaid > $0 but less than billed amount
DeniedCLP02 = 4 or paid amount = $0
Unmatched837 claim not found in 835 ERA
⊞ Results & Claim Detail
The Results page shows a summary dashboard and filterable claim table. Click any row to open the full Claim Detail view.
Summary cardsTotal, matched, partial, denied counts
Match rate barVisual % of fully matched claims
Filter by statusShow only matched, partial, denied, etc.
SearchSearch by claim ID or patient name
Claim detailFull CARC codes, service lines with DOS
↓ Excel & CSV Export
The Excel report contains 5 sheets automatically generated from your reconciliation results.
Sheet 1 - All ClaimsFull results with CARC codes
Sheet 2 - SummaryFinancials, match rate, top CARCs
Sheet 3 - DenialsDenied claims + recommended actions
Sheet 4 - PartialAdjusted claims with variance detail
Sheet 5 - Unmatched837 claims not found in 835
📝 Common Adjustment Reason Codes (CARC)
CO-16Claim lacks required information
CO-45Charge exceeds fee schedule/max allowable
CO-96Non-covered charge
CO-97Benefits not payable per plan
CO-119Benefit maximum reached
CO-A1No prior authorization
PR-1Patient deductible responsibility
PR-2Patient coinsurance responsibility
PR-3Patient co-payment responsibility
OA-23Impact of prior payer adjudication
🗑 Clear Files
After reviewing your reconciliation results, use the Clear files button on the Upload page to reset your session. This clears your uploaded 837/835 files and all results, ready for a new batch. Only your own session is cleared - other users are not affected.
HIPAA Compliance Policy
Health Insurance Portability and Accountability Act - Privacy & Security Standards
✅
This system is designed for HIPAA-compliant use
All users must review and acknowledge this policy before processing PHI.
🔒 Purpose & Scope
This system processes Protected Health Information (PHI) including patient names, dates of service, diagnosis codes, and financial data governed by HIPAA (45 CFR Parts 160 and 164). All users are subject to this policy.
👤 Authorized Users & Access
Access ControlRole-based per user account
Minimum NecessaryAccess only data for your role
Session IsolationEach user sees only their own files
CredentialsNever share username or password
📋 PHI Handling Requirements
• Do not share login credentials with others
• Exported files with PHI must be stored securely
• Do not email unencrypted PHI files
• Delete PHI exports when no longer needed
• Report unauthorized access to Privacy Officer
• Log out when leaving workstation unattended
• Exported files with PHI must be stored securely
• Do not email unencrypted PHI files
• Delete PHI exports when no longer needed
• Report unauthorized access to Privacy Officer
• Log out when leaving workstation unattended
⚠ Prohibited Activities
✕ Accessing PHI without a legitimate work reason
✕ Sharing or selling PHI to unauthorized parties
✕ Storing PHI on personal or unauthorized devices
✕ Accessing another user's files or session data
✕ Leaving the application open and unattended
✕ Using PHI beyond treatment, payment, or operations
✕ Sharing or selling PHI to unauthorized parties
✕ Storing PHI on personal or unauthorized devices
✕ Accessing another user's files or session data
✕ Leaving the application open and unattended
✕ Using PHI beyond treatment, payment, or operations
📝 HIPAA Penalty Tiers
| Violation Category | Per Violation | Annual Max | Description |
|---|---|---|---|
| Did Not Know | $100 - $50,000 | $25,000 | Unaware even with reasonable care |
| Reasonable Cause | $1,000 - $50,000 | $100,000 | Should have known, not willful |
| Willful - Corrected | $10,000 - $50,000 | $250,000 | Corrected within 30 days |
| Willful - Not Corrected | $50,000+ | $1,500,000 | Not corrected after 30 days |
📋 Acknowledgment Log
No acknowledgments recorded yet.
User Management
Add or remove user accounts. Admin access only.
Add New User
🔒 Change Admin Password
Current Users
| Username | Display Name | Role | Password | Action |
|---|
Subscription Management
Monthly subscriptions at $25.00/month per user. Admin access only.
Total Subscribers
0
Active
0
Monthly Revenue
$0
Expired / Cancelled
0
Add New Subscription
All Subscriptions
| # | User | Role | Plan | Amount | Start Date | Renewal | Status | Notes | Action |
|---|
Claim Reconciliation
Upload one or more Remittance Advice PDFs to convert to Excel.
📄
Upload Remittance Advice PDF
Select one or multiple PDF files
835 Reader
Upload an 835 remittance file to view in a clean, human-readable format.
💳
Upload 835 Remittance File
X12 EDI .txt .edi .835 — select multiple files