Billing Hub User Guide

1. Welcome

One Care Portal (OCP) is a secure workspace built for home and community-based care programs. The Billing Hub is OCP's Revenue Cycle Management (RCM) module — it gives your billing team a single place to submit electronic claims to payers, track payment status, verify patient eligibility, work denials, and reconcile remittance payments.

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

What you can do in Billing Hub depends on your assigned role. There are three access levels:

3. Dashboard Overview

The Billing Hub dashboard displays a grid of feature cards, one for each section of the module. Click any card to navigate directly to that feature. Cards you do not have permission to access are hidden automatically.

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. Use the filter bar at the top to narrow results:

• Status — filter by draft, ready, submitted, accepted, paid, denied, rejected, or voided
• Claim Format — filter to 837P (professional) or 837I (institutional) only
• Trading Partner — filter by the payer the claim was sent to
• Date Range — filter by service date
• Patient Name — search for a specific patient

An Error Claims badge near the top shows the count of claims with validation errors so you can quickly identify items that need attention.

Creating a Claim

1. Click New Claim.
2. Select the claim format: 837P (professional) or 837I (institutional).
3. Fill in patient information, service dates, diagnosis codes, procedure codes, and charge amounts.
4. Select the payer (trading partner) and your provider profile.
5. Click Save as Draft to save without validating, or Save & Validate to check the claim immediately.

Claim Status Workflow

Editing a Claim

You can edit claims that are in Draft, Error, or Rejected status. Claims that have been submitted or accepted cannot be edited directly — use the Create Correction action instead.

Submitting Claims

Before submitting, a claim must be in Ready status. Two ways to submit:

• Individual submit — open the claim detail and click Submit.
• Batch submit — select multiple claims on the list using the checkboxes, then click Submit Selected.

Refreshing Claim Status

After submission, the portal polls the clearinghouse automatically. To manually sync the latest acknowledgment or payment status, click Refresh Status on the claim detail page, or select claims in the list and click Refresh Selected.

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 Detail View

The claim detail page gives you the full picture for a single claim:

• Patient info — name and member ID
• Claim status badge — current state in the workflow
• Acknowledgment status — whether the 277CA was accepted or rejected, with rejection codes if applicable
• Service date, diagnosis and procedure codes, charge amount
• Total Paid / Total Adjusted — amounts posted from the ERA
• Related payments — individual 835 payment records linked to this claim
• Submission history — timestamps for each status change
• Error messages — expand to see the full error detail if the claim was rejected by the clearinghouse

5. Upload Claims (Excel Import)

If you manage claims in a spreadsheet, the Upload feature lets you import them in bulk instead of entering each one manually. The portal accepts .xlsx, .csv, and .xls files.

Generating a Template

If you don't already have a spreadsheet format, click Download Template to get a pre-formatted Excel file with all required and optional columns labeled. Fill it in and upload it back when ready.

Mapping Columns

After uploading your file, the portal shows a column mapping screen where you match your spreadsheet columns to the required claim fields:

1. Select your uploaded file.
2. For each required field, choose the matching column from your file using the dropdown.
3. For columns your file doesn't include, you can set a default value that will apply to every row.
4. Click Save as Import Profile to reuse this mapping next time — or select an existing saved profile to skip this step.

Validating and Importing

1. Click Validate. The portal checks every row for missing required fields, invalid dates, bad diagnosis codes, and format issues.
2. Rows with errors are listed with the specific field and problem so you can fix them in your spreadsheet and re-upload, or skip those rows and import only the valid ones.
3. When you're satisfied, click Import. Valid rows become draft claims.

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
• Denial Amount — the dollar amount denied
• Denial Date — when the ERA was received
• Resolution Status — current working status (see below)

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 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
• Resolution Status — pending, resolved, or written off

Resolving a Payment

1. Click Resolve on the payment entry.
2. Search for the correct claim by patient name or claim ID.
3. Select the matching claim and click Apply Payment — the payment is posted to that claim and its status updates accordingly.
4. If the payment is not collectible or belongs to an error, click Write Off and add a note explaining the reason.

10. Import Batch History

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

Viewing Batches

The batch list shows:

• File name and import date
• Total rows, valid rows imported, and error count
• Status — completed, pending, or failed

Click any batch to see the list of claims that were created and, if there were errors, a detailed breakdown of which rows failed and why.

Retrying a Failed Batch

If a batch failed due to a system error (not a validation error), click Retry to reprocess it. Validation errors require you to fix your source file and upload again.

11. Settings (Admin Only)

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

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 Provider Profile.
2. Enter the provider name, NPI, Tax ID, taxonomy code, 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 Status on the profile card to sync the clearinghouse 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 Add 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. Common Workflows

Workflow 1: Full Claim Lifecycle (Draft to Payment)

1. Create a claim manually or upload via Excel. The claim starts as Draft.
2. Validate the claim — it moves to Ready if all required fields are correct.
3. Select the claim(s) and click Submit Selected. Status becomes Submitted.
4. Wait for the 277CA acknowledgment. The portal polls automatically — or click Refresh 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 and search for the correct claim by patient name or claim ID.
4. Select the matching claim and click Apply Payment.
5. If no matching claim exists or the payment is an error, click 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 Status.
2. Go to Settings → Enrollments → Add 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.

13. Quick Reference

Claim Status Reference

Common CARC Denial Codes

EDI Transaction Type Reference

Feature Navigation