Billing

Manage your entire revenue cycle

The Fieldworker platform lets you manage the revenue cycle in multiple ways. The Billing page is the primary entry point for managing all Billing-related functionality. All admins in your company will have access to this page. The Billing module, also referred to as Revenue Management, serves as the financial command center for your agency. This page provides a high-level dashboard to track receivables, monitor claim health, and analyze payment trends.

📊 1. Financial Summary Dashboard

The main view provides an aggregate look at your agency's finances for a specific month. Key metrics include:

• Total Receivable: The total of all potential and processed revenue for the selected period.

• Total Receivable By Prior Auth Status: Instantly see which portions of your revenue are backed by a Prior Authorization versus those tied to a DDD Voucher.

• Total Receivable By Payment Source: Breaks down your income by payer, such as NJMMIS or Voucher.

• Total Receivable By Account Code: Categorizes revenue based on the client's plan lifecycle (e.g., Active Plan, Plan Renewed, or Initial Plan).

🔄 2. Payment Status Pipeline

This section is the "pulse" of your billing department, showing exactly where your money is in the workflow:

Status	Description
Ready to Bill	Documentation is complete and ready for submission to the payer.
Released	Claims have been officially submitted and are awaiting payer response.
Processed as Primary	The claim has been successfully processed by the primary insurance.
Denied	Claims rejected by the payer that require correction and resubmission.
Pending	Claims currently being reviewed by the insurance provider.
Voucher Payment Received	Funds have been successfully collected for voucher-based services.

🛠️ 3. Navigation & Tools

• Date Selector: Use the calendar tool or the [] and [] arrows to navigate between months to audit historical data or project future revenue.

• Print Functionality: Click the [] icon to generate a PDF or physical copy of the financial summary for stakeholder meetings.

• Sub-Module Icons (Top Right):

  • Pie Chart: Returns you to this Financial Summary view.

  • Claims/Details: Access the line-item level view of every billable task.

  • Remittances: Manage incoming payments and EOB (Explanation of Benefits) files.

  • Reports: Generate advanced financial exports for accounting software.

If your Total Receivable is $0.00 for the current month, ensure that your staff have finalized their Timesheets and that those sessions have been marked as "Approved" in the Scheduler.

Core Billing Workflow

Fieldworker integrates with claims.io as its primary medical billing clearinghouse to automate the transmission of healthcare claims to insurance payers. This integration acts as a "digital bridge," ensuring that the data you collect in Fieldworker is scrubbed, formatted, and delivered securely.

claims.io is a HIPAA-compliant healthcare clearinghouse that specializes in Electronic Data Interchange (EDI). In the Fieldworker ecosystem, it serves as the intermediary that translates your agency’s visit and service data into the standardized formats (like ANSI X12 837) required by insurance companies and Medicaid.

1. Claim Generation & Pre-Validation

Before data ever leaves Fieldworker, the system uses the Billing Information you've configured to "pre-scrub" the claim.

• Data Source: Fieldworker pulls from your recorded timesheets, EVV data, and client profiles.

• Validation: The system checks for missing NPIs, invalid Taxonomy codes, or expired authorizations.

2. Transmission to claims.io

Once a claim is marked for submission, it is sent via an encrypted API to claims.io.

• Claim Scrubbing: claims.io performs a secondary, more intensive "clean claim" check. It looks for payer-specific rules—for example, ensuring a specific Medicaid modifier is present for a New Jersey DMAHS claim.

• Routing: Based on the Payer ID set in your Billing tab, claims.io routes the file to the correct destination (e.g., NJ Medicaid, Aetna, or a specific MCO).

3. Real-Time Status Tracking

The integration provides two-way communication, allowing you to see the claim's journey without leaving Fieldworker:

• Rejections: If a claim is rejected (e.g., "Member Not Found"), the error code is sent back from claims.io and displayed in your Fieldworker dashboard.

• Acknowledgements: You receive instant confirmation when a payer has successfully received and queued a claim for adjudication.

4. Electronic Remittance Advice (ERA/835)

When a payer processes a payment, they send an ERA (835 file) back through claims.io.

• Auto-Posting: Fieldworker consumes this file to automatically update the status of your claims to "Paid," "Denied," or "Partial Payment."

• Denial Management: If a claim is denied, the specific reason code (CARC) is pulled into Fieldworker, allowing your billing team to correct and resubmit the claim immediately.

Technical Credentials

To maintain this connection, your Fieldworker Billing > Credentials section must be populated with:

• Client ID & Secret: These are the unique "keys" provided by claims.io that allow the two platforms to talk securely.

• Business Entity ID: Your unique identifier within the claims.io network.