Dual-lane claims: professional 837P/CMS-1500 (scrub → 837P → submit → 999/277CA → remittance) AND institutional 837I/UB-04 for TX-Medicaid home-health S9110, branching on claim_type. Two fail-closed gates protect the institutional lane: a BAA org-mapping (no signed BAA → no claim) and a 278 prior authorization (no approved auth in effect → no submission). Fail-closed billing identity (NPI/TIN). billing-service behind claim:read/write/submit, payment:post, billing:org-map, auth:read/request.
Standard of work · ISO/IEC 25010 — Meets 9/9
- 1. Self-identifyingUsability — appropriateness recognizabilityThe page names itself: breadcrumb, title, section, status badge, and a page id.
- 2. Navigable forward & backUsability — operabilityBack/Next step through the product; breadcrumb + active sidebar; browser back works.
- 3. Demo-prefilled — no empty statesUsability — learnabilityEvery form is pre-filled with realistic demo data so the screen is never blank.
- 4. Accessible — AAA, large fonts, big targetsUsability — accessibilityLight mode, 7:1+ contrast, ≥44px controls — built for a 76-year-old physician.
- 5. Clear result feedbackFunctional suitability — appropriateness; Reliability — fault toleranceEvery action maps a Result to a visible success/error message; codes → HTTP status.
- 6. Secure by default + sign-outSecurity — confidentiality & authenticityDefault-deny permissions, practice-scoped data, a sign-out control, no PHI in logs.
- 7. ResponsivePortability / Compatibility — adaptabilityWorks on desktop, tablet, and phone; the sidebar collapses on narrow screens.
- 8. ResilientReliability — availability & recoverability; Performance efficiencyLoading and upstream-down states are handled — never a blank or frozen screen.
- 9. ConsistentMaintainability — modularity & reusabilityOne shell, one set of design tokens, shared components across every page.
Billing / Claims
Claims (0)
No claims yet. Draft one above.
Select a claim, or draft a new one.
Home-health billing entities (837I) — the BAA gate
A home-health claim is FAIL-CLOSED: it cannot be built until an active mapping has a signed Business Associate Agreement on file. Generate one from a confirmed RPM monthly report on the Remote Monitoring page.
No home-health billing entities yet. Add one above.
Prior authorization (278) — the 837I submission gate
FAIL-CLOSED: a home-health claim cannot be submitted until an approved 278 is in effect for its service date. The mock approves S9110 telemonitoring for a TX-Medicaid payer up to a 31-day monthly ceiling; a larger ask pends for review; a non-Medicaid payer is denied. TMHP form F00032, rev 0780. DEMO day counts/windows — confirm vs TMPPM before live billing.
No authorizations yet. Request one above (for Eleanor Whitfield, the demo home-health patient).