Revenue Cycle Management (Billing Hub) User Guide

1. Welcome

Revenue Cycle Management (RCM) in One Care Portal is delivered through the module labelled Billing Hub inside the portal. This guide uses that on-screen name.

One Care Portal’s Billing Hub is a standalone-or-connected Revenue Cycle Management (RCM) module for provider agencies. It works with your current care or documentation system or connects to One Care Portal Case Management or the Care Module, giving your billing team one place to submit electronic claims, track payment status, verify patient eligibility, work denials, and reconcile remittance payments.

Billing Hub supports all major payer types — Medicaid and Medicaid MCOs, Medicare and Medicare Advantage, and commercial payers — through supported clearinghouse workflows. It does not require an HCBS or waiver program. Exact payer, plan, transaction, enrollment, and claim-type fit is confirmed during setup.

This guide covers the Billing Hub module. Separate guides are available for the Case Management and Care Module.

Key Terms

2. Getting Started

Accessing the Billing Hub

1. Log in to One Care Portal with your email and password.
2. On the Service Overview page, click the Billing Hub service card.
3. You will land on the Billing Hub dashboard showing all available features.

Roles and Permissions

Billing Hub has one main role. There is no separate view-only role.

• Billing Hub Access is required for every Billing Hub user, including your organization's administrators.
• Settings requires being an administrator and having Billing Hub Access.
• ERA Dashboard Access opens only the ERA pages.

3. Dashboard Overview

The Billing Hub dashboard displays a grid of feature cards, one for each section of the module. Click the button on a card to go to that feature. Cards you do not have permission to use are hidden automatically.

Users who hold only ERA Dashboard Access see the ERA Files and Provider Revenue cards.

4. Claims Management

The Claims page is the central hub for your billing workflow. From here you can view all claims in your organization, filter them by status or payer, submit batches to the clearinghouse, and track acknowledgment and payment status.

Viewing and Filtering Claims

The claims list shows all claims for your organization, with the patient, status, 277CA acknowledgment, format, service date, and billed amount. Use the filter bar at the top to narrow results:

• Status — Draft, Error, Ready, Submitted, Accepted, Accepted for Processing, Rejected, Paid, Denied, or Voided
• Format — 837P (Professional) or 837I (Institutional)
• 277CA — filter by acknowledgment status
• From / To — filter by service date
• Patient — search by name

An Error Claims button near the top shows the count of claims with validation errors. Click it to show only those claims.

Where Claims Come From

Claims are not typed in one at a time. They arrive in Billing Hub in two ways:

• Excel import — click Upload Excel and follow the import steps (see Upload Claims). This is also how billing exports from Case Management and the Care Module are brought in.
• Corrected claims — created from an existing denied or partially paid claim with Create Correction.

Imported claims start as Draft, or as Error when a row has problems that need fixing.

Claim Status Workflow

Editing a Claim

Click Edit on a claim in Draft, Error, Ready, or Rejected status to correct it. Claims that have been submitted or accepted cannot be edited directly; use Create Correction instead.

Marking Claims Ready and Submitting

A claim must be in Ready status before it can be submitted.

1. Review your draft claims. Click Mark Ready on a single claim, or Mark Page Drafts Ready to mark every draft on the current page.
2. Tick the checkboxes for the ready claims you want to send. The checkbox in the header selects all ready claims on the page.
3. Click Submit Selected.
4. Stay on the page until the submission finishes. Leaving part-way through may stop the remaining submissions.

Submission requires an active LIVE enrollment for that payer and claim format. If submission fails, check that the appropriate enrollment is live in Settings → Enrollments.

If a Submission Is Unconfirmed

Occasionally the clearinghouse does not confirm whether it received a claim. The claim is then marked Submission unconfirmed. Do not submit it again until someone has verified the outcome with the clearinghouse, because resubmitting could create a duplicate. An administrator with Billing Hub Access then reconciles it by choosing Received — Mark Submitted (entering the clearinghouse claim ID) or Not Received — Return to Draft.

Checking Claim Status and Pulling Payments

• Check Status — open a claim's Claim Details and click Check Status to ask the clearinghouse for the latest acknowledgment.
• Process Available ERAs — on the Claims page, click this to pull pending 835 remittances from the clearinghouse and post payments to claims. The page shows when it was last synced.

Creating a Corrected Claim

When a claim is denied, you can create a corrected version rather than starting from scratch. Open the denied claim, click Create Correction, and the portal will pre-populate all fields from the original. Edit the fields that caused the denial, then submit the corrected claim as a new submission. The corrected claim is linked back to the original in the claim detail view.

Voiding a Claim

To cancel a claim that should not be submitted, open it and click Void. Voiding is available for claims in Draft or Ready status. Once voided, the claim cannot be re-opened — create a new claim if needed.

Reading the Claim Details

Opening a claim shows Claim Details for that claim:

• Patient Information — name and member ID
• Claim Information — format, service date, payer, and control number
• Financial — charge amount, paid amount, adjustment amount, and remaining balance
• Denials — each denial code and reason, with date and amount
• Payment History — each 835 payment posted to the claim, marked Auto-Matched or Manual Match
• Timeline — when the claim was created, submitted, acknowledged, and last paid
• Clearinghouse Information — reference IDs for tracing the claim with the clearinghouse

If a claim has an error, the message is shown on its row in the claims list; click it to see the full detail.

5. Upload Claims (Excel Import)

Billing Hub > Upload Claims > Upload Excel

The Upload feature imports claims in bulk from a spreadsheet. It accepts Excel files (.xlsx and .xls) with headers in the first row. CSV files are not accepted; save them as Excel first.

The import has four steps, shown across the top of the page: Upload, Map Columns, Preview, and Complete.

Step 1: Upload

1. Select the Provider Profile the claims will be billed under.
2. Select the Claim Format: 837P (Professional) or 837I (Institutional). The format determines which fields are required.
3. Drag and drop your Excel file, or click to browse.

Need a starting point? Click Download 837P Template (or Download 837I Template, depending on the format selected) for a pre-formatted Excel file with sample data.

Step 2: Map Columns

Match the columns in your spreadsheet to the required claim fields. Billing provider details (NPI, name, address, contact information, and Tax ID) are filled in automatically from the provider profile you selected, so they do not need to be in your file. The page lists any required fields that are not yet mapped.

Step 3: Preview

Click Preview Claims. Rows are grouped into claims, and each claim may contain several service lines. The preview shows the number of claims, service lines, total charges, and how many have errors, with the specific problem for each. You can go Back to Mapping, fix the spreadsheet and upload again, or continue.

Step 4: Create Claims

Click Create Claims. The Import Complete screen shows how many claims were created, how many were created as Error Claims, and any rows that failed.

Reusing a Column Mapping

Import profiles save your column mappings so they do not have to be redone for every file. Administrators create them under Settings → Import Profiles (see Settings).

6. Eligibility Checks

Run a real-time eligibility check (270/271) before submitting a claim to verify that a patient is covered by their payer on the date of service. This helps avoid denials due to inactive coverage or missing authorizations.

Prerequisites

To run eligibility checks, your provider profile must have a LIVE enrollment for the 270 (Eligibility) transaction type with the target payer. Ask your tenant administrator to set this up in Settings → Enrollments if it's not already in place.

Running a Check

1. Navigate to Billing Hub → Eligibility.
2. Select your Provider Profile (NPI and address).
3. Enter the patient's Member ID, Name, and Date of Birth.
4. Select the Payer (trading partner).
5. Click Check Eligibility.

Reading the Results

The result card shows:

• Coverage Status — active, inactive, or partial
• Authorization Required — whether the payer requires prior auth for the service
• Plan Info — copay, deductible, and benefit limits when provided by the payer
• Auth Number & Dates — if an active authorization is on file
• Raw 271 Response — expandable section for the full EDI response if you need the underlying data

Check History

All past eligibility checks are stored and searchable. Use the history tab to look up previous results by provider, member ID, or payer, sorted with the most recent checks first.

7. Denial Management

When a payer denies a claim or line item, an entry appears in the Denial queue. Denial Management gives your billing team a structured workflow to resolve each denial rather than tracking them in a spreadsheet.

Reading the Denial Queue

Each denial entry shows:

• Claim ID — a link to the related claim
• CARC Code & Reason — the standardized denial reason from the payer's 835
• Amount Paid — the amount the payer paid on the denied item
• Denial Date — when the ERA was received
• Resolution Status — current working status (see below)

Filter the queue by Resolution Status and by Denial Date From / Denial Date To.

Resolution Workflow

Click Work on any denial to open the resolution modal. Set a status, add notes, and optionally link a corrected claim ID:

8. AR Aging Report

The Accounts Receivable (AR) Aging Report shows you how much money is outstanding across your submitted and accepted claims, broken down by how long each balance has been unpaid. Use it to prioritize follow-up and identify stale claims that need attention.

Generating the Report

1. Navigate to Billing Hub → AR Aging → View Report.
2. Optionally filter to a specific Provider Profile.
3. Set the As of Date (defaults to today).
4. Click Generate Report.

Reading the Report

The report displays:

• Total Outstanding — the sum of all unpaid balances and total claim count
• 0–30 days — recent claims still within typical payment turnaround
• 31–60 days — claims approaching the follow-up threshold
• 61–90 days — claims requiring active follow-up
• 90+ days — significantly aged claims that may need escalation or write-off

Each bucket shows the total balance, claim count, and percentage of total AR. A stacked bar chart visualizes the aging distribution at a glance.

Exporting

Click Export CSV to download the full aging detail for use in external reporting or practice management workflows.

9. Unmatched Payments

When an 835 ERA is processed, OCP automatically matches each payment record to the corresponding claim using the Patient Control Number (PCN). If a payment can't be matched — because the PCN doesn't exist, was already voided, or is a duplicate — it lands in the Unmatched Payments queue for manual review.

Reading the Queue

Each entry shows:

• PCN — the patient control number from the 835, if present
• Payment Amount & Date
• Remittance ID — the 835 file this payment came from
• Failure Reason — claim not found, PCN mismatch, duplicate, or other
• Status — Pending, Matched, or Written Off

Resolving a Payment

1. Click Resolve on the payment entry. The Resolve Payment dialog shows the amount, control numbers, remittance ID, and the 835 payment details, including service lines and denial codes.
2. Choose how to resolve it: Match to Claim or Write Off.
3. To match, search for the claim by patient name and select it, or choose Enter ID manually and type the claim ID.
4. Add optional Notes and confirm. A matched payment is posted to that claim and the claim's status updates.

Use Write Off when the payment is not collectible or belongs to an error, and add a note explaining why. If a payment was resolved incorrectly, open it again and click Change Resolution.

10. Import Batch History

Billing Hub > Import History > View Batches

Every Excel import creates a batch record so you can audit what was imported, when, and with what results.

Viewing Batches

The list shows the File Name, Status, Claims (how many were created and how many rows were invalid), Imported By, and when the import Started.

• Click Details on a batch to see the claims it created and, if there were errors, which rows failed and why.
• Click New Import to start another upload.

A batch cannot be re-run. If rows failed, fix your source file and upload it again, or correct the error claims directly in the Claims list.

11. Settings (Admin Only)

Settings has four tabs: General, Provider Profiles, Enrollments, and Import Profiles. Provider profiles and enrollments must be configured before your team can submit claims or run eligibility checks.

General Tab

The General tab appears when your organization also uses Case Management. Under Billing Rules:

• Require supervisor approval for billable contact notes — when enabled, only supervisor-approved contact notes are included in the Case Management 837P export. Unapproved notes appear there as blocking errors.

Click Save to apply the change.

Provider Profiles Tab

A Provider Profile is your organization's billing identity registered with the clearinghouse. You need at least one before you can submit any claims.

To create a provider profile:

1. Click Add Profile.
2. Enter a Profile Name, the Provider Type (Organization or Individual), the provider's legal name, NPI, Tax ID (EIN or SSN), and billing address.
3. Add a contact name, phone, and email.
4. Click Save. The profile is automatically registered with the clearinghouse (Stedi).

After saving, click Refresh Clearinghouse Status to sync the registration status. Once registered, the status updates to Registered and the profile is ready for enrollment creation.

Enrollments Tab

An enrollment is an approved electronic trading relationship between your provider profile and a specific payer. You need a LIVE enrollment for each transaction type you want to use with each payer.

To create enrollments:

1. Click New Enrollment.
2. Select the Provider Profile.
3. Select the Payer (trading partner).
4. Check all the Transaction Types you need: 837P, 837I, 270 (eligibility), 276 (claim status), 835 (remittance).
5. Click Create. One enrollment record is created per selected transaction type, all in Draft status.

Enrollment status lifecycle:

Import Profiles Tab

Import profiles save your Excel column-to-claim-field mappings so billing staff don't have to re-map columns every time they upload a file. Create one profile per spreadsheet format you use. Each profile is tied to either 837P or 837I claim format.

12. ERA Dashboard

Billing Hub > ERA Files

The ERA Files section lets you upload raw X12 835 Electronic Remittance Advice (ERA) files received directly from payers or clearinghouses. Each uploaded file is parsed automatically: claim payment records are matched to your submitted claims by Patient Control Number (PCN), claim statuses update, and denials are captured. You can then drill into an individual file's ERA Dashboard for a detailed breakdown of payments, denials, and checks.

Uploading an ERA File

1. Navigate to Billing Hub → ERA Files.
2. Drag and drop your 835 file onto the upload area, or click the area to browse for the file. Accepted formats are .835, .txt, .edi, .era, and .rmt.
3. The portal validates the file structure, parses all X12 transactions, and matches claim records to your submitted claims automatically.
4. A success message confirms the number of claims processed and the number of checks posted.

ERA Files List

Below the upload area, the Uploaded Files table shows all previously processed ERA files. Each row displays:

Reparse — Use the Reparse button on any file row to re-process the stored file with the latest parsing logic. This is useful if a file initially failed to process or if claim matching has been updated since the original upload.

Per-File ERA Dashboard

Click View Dashboard on any ERA file to open the ERA Dashboard for that file. The dashboard gives you a comprehensive view of everything in that remittance.

Summary Metrics

A row of summary cards at the top of the dashboard shows key totals for the file:

Below the totals, Final claim outcomes breaks the claims down into Paid, Underpaid, Zero-pay, Denied, and Reversals. Each claim is counted once, at its latest payer outcome, even if the file contains several records for it.

Claims Tab

The Claims tab lists every claim-level record from the ERA. Use the Search field (patient name, member ID, or claim number) and Status filter to narrow the list. Denied claims are sorted to the top by default.

Each row shows the patient, member ID, claim number (PCN), claim status, billed amount, paid amount, patient responsibility, the top denial reason code, and whether the ERA claim was matched to an OCP claim. Click Details on any row to open the full claim detail panel, which includes all adjustment and service-line codes.

Use Export Claims CSV to download the filtered claim list, or Export Raw CSV (top right of the page) for an audit export that includes every claim payment record in the file.

Denial Analytics Tab

The Denial Analytics tab aggregates denial reason codes from the ERA and shows a breakdown by CARC (Claim Adjustment Reason Code) and RARC (Remittance Advice Remark Code). Use this view to quickly identify the most common denial reasons for this payment batch and prioritize corrective actions.

By Provider Tab

The By Provider tab totals the file by rendering provider: paid, billed, allowed, patient responsibility, and contractual adjustments, with each provider's NPI. Click View claims on a provider to filter the Claims tab to that provider. Some payers bill everything under the group NPI and do not report individual clinicians; the tab says so when that is the case. If totals are unavailable for an older file, reparse it from the ERA Files page.

Checks Tab

The Checks tab shows each individual remittance transaction (BPR segment) from the ERA, including:

• Check/EFT number — the payment identifier from the payer.
• Payment method — check, EFT, or other.
• Payment date — when the payment was issued.
• Amount — total payment amount for this check.
• Payer and payee — including NPI and Tax ID where available.
• Status — whether the check has been posted or has an error.

If the ERA contains Provider-Level Adjustments (PLB), they appear below the checks table. PLB adjustments modify the check amount outside of individual claims (e.g., recoupments, prior-period adjustments). The table shows the reason code, description, reference ID, and adjustment amount.

Provider Revenue

Billing Hub > Provider Revenue > View Provider Revenue

ERA Revenue by Provider ranks rendering-provider revenue across all the ERA files you have uploaded, not just one file. Filter by payer and by date to compare periods. Use it to see which clinicians or locations account for paid revenue and where payments are falling short of what was billed.

13. Common Workflows

Workflow 1: Full Claim Lifecycle (Draft to Payment)

1. Upload claims via Excel. Each claim starts as Draft.
2. Review the claim and click Mark Ready (or Mark Page Drafts Ready). It moves to Ready.
3. Select the claim(s) and click Submit Selected. Status becomes Submitted.
4. Wait for the 277CA acknowledgment. The portal polls automatically — or open the claim and click Check Status to check immediately. Status becomes Accepted.
5. When the payer processes the claim, they send an 835 ERA. Click Process Available ERAs on the claims page to pull pending remittances from the clearinghouse.
6. The portal matches payments to claims by PCN. Status updates to Paid, Partially Paid, or Denied based on the ERA content.

Workflow 2: Handling a Denied or Rejected Claim

1. On the Claims list, filter by Status: Denied or Status: Rejected.
2. Open the claim and review the error or CARC code in the detail view.
3. If Rejected (clearinghouse rejection) — the claim returns to Draft. Correct the field that caused the rejection and re-submit.
4. If Denied (payer denied the service) — click Create Correction, fix the identified issue, and submit the corrected claim. Alternatively, navigate to Denial Management to log the denial and track your resolution action (appeal, write-off, etc.).

Workflow 3: Running a Pre-Billing Eligibility Check

1. Navigate to Eligibility Checks.
2. Select the Provider Profile that will bill for the service.
3. Enter the patient's member ID, name, and date of birth.
4. Select the Payer.
5. Click Check Eligibility. Results return in seconds.
6. Confirm coverage is active and note any authorization requirements before scheduling the service or submitting a claim.

Workflow 4: Reconciling Unmatched Payments

1. Navigate to Unmatched Payments.
2. Review the failure reason for each payment (claim not found, PCN mismatch, duplicate, etc.).
3. Click Resolve, choose Match to Claim, and search for the correct claim by patient name or enter its ID.
4. Select the matching claim and confirm.
5. If no matching claim exists or the payment is an error, choose Write Off with an explanatory note.

Workflow 5: Onboarding a New Payer

1. Go to Settings → Provider Profiles. Confirm your provider profile exists and shows Registered status. If not, create one and click Refresh Clearinghouse Status.
2. Go to Settings → Enrollments → New Enrollment.
3. Select your provider profile and the new payer. Check all transaction types you need (837P, 270, 835, etc.).
4. Click Create — enrollment records appear in Draft.
5. Click Submit on each enrollment to send to the payer.
6. Periodically click Sync to check status. Wait for each enrollment to reach Live before submitting claims or checking eligibility for that payer. Processing times vary by payer — typically 3–10 business days.

Workflow 6: Bill Case Management Contact Notes

1. In Case Management, open Reports → Billable Contact Note Export (837P), preview the period, and resolve any blocking errors (see the Case Management guide).
2. Click Download Excel.
3. In Billing Hub, click Upload Excel, select the provider profile and the 837P format, and upload the file.
4. Map the columns, preview, and click Create Claims.
5. Mark the claims ready and click Submit Selected.

14. Quick Reference

Claim Status Reference

Common CARC Denial Codes

EDI Transaction Type Reference

Feature Navigation

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