For Billing Teams
Every Chart Arrives Billing Ready
The Revenue Integrity Engine enforces required fields before submission, calculates ASA units in real time with payer specific rounding, scores claim readiness on a 0 to 100 scale, and tracks every rejection at the field level with correction workflows.
Hard Stops on Every Required Field
Tier 1 — Universal Hard Blockers
Required on every billable case regardless of type, payer, or provider role.
- 1Rendering Provider NPI
- 2Patient Date of Birth
- 3Anesthesia Start Timestamp
- 4Anesthesia End Timestamp
- 5Primary Diagnosis ICD 10
- 6Procedure CPT Code
- 7Anesthesia Type
- 8ASA Physical Status Classification
- 9Place of Service Code
Tier 2 — Contextual Blockers
Required when specific conditions apply.
- Supervising Provider NPI (when CRNA is supervised)
- Emergency Flag
- Qualifying Circumstance Codes
- Estimated Blood Loss (when blood products administered)
- Regional Technique Detail
- OB Specific Fields
- Pediatric Weight Confirmation (patient under 12)
A claim cannot advance to Billing Ready status until every applicable field is complete.
Real Time Unit Calculation With Payer Specific Rounding
Total Units = Base Units + apply_rounding(raw_minutes, payer_rule) + Qualifying Circumstance Units
Payer Rounding Rules
- Ceiling 15 minute
- Ceiling 7 minute
- Per minute
Rounding configures at the payer level. The calculation runs in real time during the case.
Modifier Derivation
Modifiers derive automatically from provider role, supervision model, and ASA status. Derivation logic is stored for audit defensibility.
Every input to the calculation persists as a discrete auditable field.
Seven State Case Lifecycle
- 1Scheduled
- 2Clinically In Progress
- 3Chart Complete
- 4Billing Ready
- 5Claim Generated
- 6Rejected / Needs Correction
- 7Closed
- 1. Scheduled
- 2. Clinically In Progress
- 3. Chart Complete
- 4. Billing Ready
- 5. Claim Generated
- 6. Rejected / Needs Correction
- 7. Closed
Every stakeholder shares this language for case state.
Claim Readiness Score: 0 to 100
Each case receives a score reflecting the probability of clean first pass adjudication based on historical rejection patterns. Billing staff use the score to prioritize review; hard blockers remain the submission gate.
Clean — Billing Ready
Ready to submit
Review Required
Missing modifier
Blocked
Hard blocker present
Every Rejection Feeds Back at the Field Level
When a claim is denied, AIMS captures: payer reason code, affected case ID, responsible provider, the specific field flagged, and a correction workflow. This data accumulates into provider specific error patterns and payer specific rejection analytics.
999
Structural
Format errors caught before payer processing. Immediate feedback on EDI validity.
277CA
Transport
Payer confirms the claim was accepted for adjudication. Assigns a tracking number.
835
Remittance
Payment or denial with reason codes. Denial reason routed to the responsible provider.
837P Generation Through Clearinghouse
AIMS generates 837P (SV2 loop) claim files for anesthesia. Claims route through Availity or Waystar for payer connectivity.
999
Structural EDI validity
277CA
Payer accepted for adjudication
835
Remittance and adjudication result