New claim
Claims
| Claim # | Status | Created |
|---|
Claim
Ledger (chronological — a permanent record, entries are never changed)
| Date | Event | Amount | Code | Source | Recorded |
|---|
Add an event manually
Events normally arrive through Data Intake (837 claims, 835 payments). Use this only for an event that did not come in a file. Every event is permanent; a correction is a new event.
Exceptions
| Type | Status | Raised |
|---|
Reconciliation
Run history — every check is kept in this claim's permanent record
| Run | Result | Claimed | Paid | Variance | By |
|---|
Documentation readiness
Is the file for this claim complete before a post-payment audit asks for it? Checks only that a document of each kind is in the Evidence Vault for this claim — it does not read the document or judge whether it supports the service.
| Requirement | Status | Evidence Vault type that counts |
|---|
Remittances (835)
What the payer's 835 files say about this claim, as the payer sent them: claim status, amounts, adjustment codes and service lines. Captured when an 835 is imported on the Data intake tab.
Money the payer wants back on this claim
Record a demand
| Demanded | Notice date | Reason | Respond by | Status |
|---|
Cases
Open a case to work on one payer demand, or one problem iClaimsGuard found, on this claim.
| Case # | Type | Status | Respond by |
|---|
A connection lets a partner, such as a TPA, see specific parts of your practice's data. You choose what they may see, you can stop sharing at any time, and every time a partner opens your information it is recorded. Only your practice administrator can start or stop sharing.
Share with a partner
Your connections
| Partner | Direction | What is shared | Dates | Status |
|---|
Store the documents that prove your claims — EOBs, remittances, medical records, letters. Every file is locked against changes when you upload it, so you can show a payer or an auditor that it is exactly what you uploaded.
Upload document
One document can cover several claims — a remittance or an authorization letter often does — so add every claim it covers. Leave claims and case empty for a document that stands on its own.
How documents are protected
Each file gets a fingerprint (a SHA-256 hash) the moment it is uploaded and is stored encrypted (AES-256-GCM). If even one byte of the stored file ever changed, its fingerprint would no longer match — that is what “Check” below tests.Documents
| File | Claims covered | Type | Size | Fingerprint | Status | Uploaded |
|---|
Check a document
Confirms, right now, that the stored file is exactly the one you uploaded — it re-reads the file and compares its fingerprint, rather than trusting an earlier result.
Import a file
Claims, payments, adjustments and payer demands in CSV, Excel or X12 (837/835) are processed on upload. Every upload is its own numbered, permanent entry in the upload log below. A file identical to an earlier upload loads nothing and says so.
Upload log — newest first, every upload kept permanently
| Upload | File | Record type | Uploaded | By | Outcome |
|---|
Import exception queue
| Upload | Row | Error type | Detail | Status |
|---|
Import batch
Row exceptions in this batch
| Row | Error type | Detail | Status |
|---|
Your plan sets how much your practice can keep in iClaimsGuard — claims, documents, people who can sign in, and reports each month. Below you can see what you are using, compare plans, and change, pause or cancel.
Your plan
What you are using
| What | Using now | Your plan allows |
|---|
Compare plans
Pause or cancel
Add-ons
Add-ons are recorded on your account for billing and for partner records. None of them switches a screen on or off today.
| Add-on | Status | Added |
|---|
Practice profile
Change your password
When you change it, every other device where you are signed in is signed out at once. This device stays signed in.
Forgot your current password? Sign out, then choose Forgot password? on the sign-in screen. AnswerPoint will email you a link to choose a new one.
Generate the documents you send to payers and auditors. Pick a report, choose what it covers, and download it. Every report you generate is kept under Recent.
Provider financial-control dashboard
Cases needing attention
| Case # | Type | Status | Deadline | Priority |
|---|
Latest payment integrity score
Latest verified receivables snapshot
Documentation readiness — paid claims
| Claim # | Paid | Gaps |
|---|
Recoupment is when a payer asks for money back on claims it already paid, or simply keeps it out of a later payment. Start here when a demand letter arrives: record it once, and iClaimsGuard tracks every claim it names and the date your response is due.
Demand letters
A demand letter usually names several claims. Record the letter once and it gets its own letter number; each claim it names appears below as a separate demand you can answer. Enter what the letter says — nothing is recorded until you have checked the preview.
Separate the parts with a tab, a | or a ; — not a comma, because amounts carry commas. Pasting rows copied from a spreadsheet works.
Preview — nothing has been recorded yet
| Line | Claim # | Amount | Reason | In iClaimsGuard | Demand on this claim |
|---|
| Letter # | Payer | Payer's reference | Letter date | Respond by | Claims | Total demanded | Status |
|---|
Claims the payer wants money back on
Every claim a payer has asked to recover money on, newest first. Click a row to see the claim, the payer's reason, and your response.
| Claim # | Letter # | Amount wanted | Date of demand | Reason | Respond by | Status |
|---|
Money already taken back
Money a payer kept back from a payment, or reversed on a claim, found in the payment files you imported in Data Intake. It is not counted against a claim until someone records it here or links it to the demand it answers.
| Payment date | Claim # | What happened | Amount | Payer / payment # |
|---|
Demand letter
Claims in this letter
Click a claim to see the demand on it and prepare your response.
| Claim # | Demanded | Reason | Status | Case |
|---|
Recoupment notice
Which audit control produced it
Records which audit control the letter names (for example, claims adjudication). Recorded only by a person, always with how it is known; a suggestion from the wording is shown but never saved.
What the finding says went wrong
The type of improper payment the finding alleges (31 U.S.C. 3351(4)) — or an "unknown payment", when the complaint is missing documentation (OMB Appendix C). Same rule: a person records it, with how it is known.
How the amount was reached
A sum of errors found on actual claims, or a projection from a sample. This platform never re-computes the payer's projection; it records the sample as the payer stated it and shows what is still missing.
The payer's sample — as the payer stated it
Sampled claims
| Payer's claim reference | Payer's finding | Our position | Basis |
|---|
Take-backs on this claim's remittances
What the 835 files show was already withheld or reversed on this claim. Only take-backs recorded against this notice count in its Recouped figure.
| Paid | What | Amount | Payer / trace |
|---|
Evidence checklist
| Item | Status | Document | Asked for by |
|---|
Add an item
Case for this demand
Close the demand
A case is your working file for contesting a payer demand, or fixing a problem iClaimsGuard found on a claim. It tracks the deadline, the evidence and the outcome. The most urgent cases are listed first.
Cases
| Priority | Case # | About | Status | Outcome | Respond by |
|---|
Case
Case record — each step is recorded permanently, with time and name
Evidence — this case and its demand
| Item | Status | Document | From |
|---|
Add an item
Financial events on this claim
From the claim's ledger — the payment being clawed back first. Nothing to re-enter.
| Date | Event | Amount | Source |
|---|
Full case history
| When | What | Who | Note |
|---|
Your integrity score runs from 0 to 100. Higher means your payments match what you billed, with few open problems, adjustments or recoupments. It is calculated only from what is already recorded here — nothing new is entered — and it is a measure of your records, not a judgment of your practice.
Calculate a score
Scores so far
Each calculation is kept as it was. For the last twelve months side by side, open the Integrity score by month report.
| Months covered | Score | Calculated on |
|---|
Payment integrity score
The six parts of the score
Each part is scored 0 to 100. A part with nothing to measure in the period is left out, and the others count for more — it is never filled in with a guess.
| Part | What it measures | Measured value | Part score | Counts for | Status |
|---|
What it was calculated from
How the score is calculated
The score looks at the claims with any entry recorded in the period — a bill, payment, adjustment or other. Each of the six parts above is turned into a 0 to 100 score, and the parts are averaged with fixed weights — Reconciled counts most (30%), Open problems and Code problems 20% each, the other three 10% each. A part with nothing to measure is left out and the others are scaled up, never filled in with a guess.
The exact method recorded with this score:
What the score is not
Receivables shows the money on your claims for a period: what you billed, how much of it payments have confirmed, how much is still open, how much is owed back on open recoupment demands, and how much is held back for review. It is calculated only from what is already recorded here.
Take a snapshot
Snapshots so far
Each snapshot is kept as it was taken.
| Months covered | Billed | Confirmed by payment | Not yet confirmed | Taken on |
|---|
Receivables snapshot
What it was calculated from
How it is calculated
Only claims with an entry recorded in the period — a bill, payment, adjustment or other — are counted. "Billed" is each claim's billed amount. A claim's money is "confirmed by payment" when its latest payment check came back matched or confirmed; everything else is "not yet confirmed", so the two always add up to what was billed. "Owed back" is what is still outstanding on recoupment demands against these claims. "Held back for review" is confirmed money on claims that have ever had a problem raised, even if it was later resolved.