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Thursday, June 5, 2026 · Assigned estimates only

ESTIMATES TODAY

14

3 more than yesterday

PENDING REVIEW

4

Awaiting admin action

SENT TO PATIENTS TODAY

9

Delivered via portal

REQUESTS FROM DOCTORS

3

New today

ESTIMATE REQUESTS

#4821

Patient A

99213 · 85025 · J0696 · Dr. Rivera

Missing info
#4820

Patient B

99214 · 93000 · Dr. Okafor

Ready to generate
#4819

Patient C

99201 · 71046 · Dr. Kim

Sent to patient
#4818

Patient D

99215 · 36415 · 80053 · Dr. Rivera

Pending review

AUDIT LOG — TODAY

9:14 am J. Lee Generated estimate #4820
9:02 am M. Obi Sent estimate to patient #4819
8:47 am J. Lee Reviewed request #4818
8:31 am S. Park Viewed patient record #4815

NEW FROM DOCTORS

ACCESS SCOPE

You have access to estimates assigned to you only. Contact your supervisor to request expanded access.

Estimate Requests

Thursday, June 5, 2026 · Assigned to you

ALL REQUESTS

14

This week

PENDING

4

Awaiting action

SENT

8

Delivered to patients

NEW TODAY

3

From doctors

Sort: Newest ⌄
REQUEST
PATIENT
DOCTOR
CPT CODES
STATUS
UPDATED
ACTION
#4821

Patient A

ECG + Office Visit

Dr. Rivera
99213 · 93000
Missing info
Just now
#4820

Patient B

Office Visit

Dr. Okafor
99214
Ready to generate
12 min ago
#4819

Patient C

Chest X-ray

Dr. Kim
99201 · 71046
Sent to patient
1 hr ago
#4818

Patient D

Stress test

Dr. Rivera
99215 · 93015
Pending review
2 hr ago
#4817

Patient E

Preventive exam

Dr. Okafor
99395
Sent to patient
3 hr ago
#4816

Patient F

Office Visit + Lab

Dr. Kim
99213 · 80053
Sent to patient
Yesterday
#4815

Patient G

Office Visit

Dr. Rivera
99212
Missing info
Yesterday
#4814

Patient H

ECG

Dr. Okafor
93000
Ready to generate
2 days ago
Showing 8 of 14 requests
Doctor's Submission Assign Codes Coverage Details Review & Send

Review & Send

Review the estimate before sending to the patient via portal.

CONFIRMED CODES

99213

Office or outpatient visit — established patient, moderate complexity

Confirmed

93000

Electrocardiogram, routine ECG with interpretation & report

Confirmed

COVERAGE DETAILS

Insurance

BCBS — Blue Cross Blue Shield

Plan Type

Commercial PPO

Member ID

XYZ-789456123

Deductible

Partially met

PORTAL MESSAGE

Optional

0 / 300

Patient name and contact details are pulled from the patient record. Not stored beyond this session.

PATIENT PREVIEW

What patient will see

This is a rough estimate only. Patient will be prompted to verify with their insurer.

ESTIMATED OUT-OF-POCKET

$150 – $420

Based on your Commercial PPO plan · Partially met deductible

99213

Office visit with your provider (established patient)

$50 – $100

93000

Routine ECG — heart activity recording

$100 – $320

QUESTIONS TO ASK YOUR INSURER

  • –Is CPT 99213 covered under my plan with this provider?
  • –Is CPT 93000 billed separately from my office visit?
  • –What is my remaining deductible balance?
  • –Does this procedure require prior authorization?

Ready to send

Estimate will be delivered via patient portal

Estimate Requests

Thursday, June 5, 2026 · #4821 sent

Estimate sent to Patient A

The cost estimate PDF has been delivered to Patient A's patient portal.

ESTIMATE SUMMARY

Patient

Patient A

Appointment

June 12, 2026 · Internal Medicine

CPT Codes

99213 · 93000

Estimated range

$150 – $420

Insurance

BCBS Commercial PPO · Partially met deductible

Sent by

J. Lee · 9:47 am

Logged in audit trail for HIPAA compliance.

NEXT STEPS

WHAT HAPPENS NEXT

Patient A will see the estimate PDF in their patient portal before their June 12 appointment. They can review the cost range, read the plain-language summary, and use the included questions when calling BCBS to confirm coverage.

Assign Codes

Step 1 of 3 — Map procedures to CPT codes

DOCTOR'S NOTES

Dr. E. Rivera · Jun 5, 2026

SOAP NOTE — #4818

CC: Chest pain, exertional S: Patient reports intermittent chest tightness over the past 2 weeks, primarily during physical activity. Denies pain at rest. No shortness of breath. No prior cardiac history. O: BP 142/88, HR 76, Wt 196 lbs. Alert and oriented. No acute distress. Heart sounds normal. A: Chest pain, unspecified (R07.9). Rule out cardiac cause. P: - Established patient office visit (high complexity) - Exercise stress test ordered to evaluate exertional chest pain - Refer to cardiology if stress test positive - Follow up within 1 week

Read-only — submitted by ordering physician

CPT CODE ASSIGNMENT

PROCEDURE (FROM NOTES) CPT CODE STATUS ACTIONS

No CPT codes assigned yet

Review the doctor's notes on the left and add the appropriate billing codes below.

CPT code selection is the billing administrator's responsibility. Suggestions do not constitute coding advice.

Assign Codes

Step 1 of 3 — Map procedures to CPT codes

DOCTOR'S NOTES

Dr. K. Okafor · Jun 5, 2026

SOAP NOTE — #4820

CC: Follow-up, Hypertension S: Patient reports no chest pain or shortness of breath. Blood pressure has been better controlled at home since medication adjustment last visit. Mild headaches in the morning, 2–3x per week. O: BP 134/82, HR 68, Wt 172 lbs. Alert and oriented. No acute distress. A: Essential hypertension, controlled (I10). Medication tolerating well. P: - Established patient office visit (low-moderate complexity) - Continue lisinopril 10mg daily - Recheck BP in 6 weeks - Follow up as needed

Read-only — submitted by ordering physician

CPT CODE ASSIGNMENT

PROCEDURE (FROM NOTES) CPT CODE STATUS ACTIONS

Established patient office visit, low-moderate complexity

99214
Confirmed

Why these codes were suggested

Based on diagnosis I10 (Essential Hypertension) and the procedure description, ClaimClear matched an established-patient office visit (99214). The notes indicate low-moderate complexity with medication management — a straightforward match. Always verify against clinical notes and payer guidelines.

CPT code selection is the billing administrator's responsibility. Suggestions do not constitute coding advice.

Assign Codes

Step 1 of 3 — Map procedures to CPT codes

DOCTOR'S NOTES

Dr. E. Rivera · Jun 5, 2026

SOAP NOTE — #4821

CC: Follow-up, Type 2 Diabetes Mellitus S: Patient reports increased fatigue over the past 3 weeks. No chest pain. Blood sugars running higher than usual per home monitoring. Last HbA1c was 8.2% (3 months ago). O: BP 138/86, HR 72, Wt 184 lbs. Alert and oriented. No acute distress. A: Type 2 Diabetes Mellitus, uncontrolled (E11.65). Hypertension, stable. P: - Established patient office visit (moderate complexity) - Routine 12-lead ECG ordered to rule out cardiac involvement given elevated BP and fatigue - Continue metformin 1000mg BID - Follow up in 3 months

Read-only — submitted by ordering physician

CPT CODE ASSIGNMENT

PROCEDURE (FROM NOTES) CPT CODE STATUS ACTIONS

Established patient office visit, moderate complexity

99213
Confirmed

Routine 12-lead ECG with interpretation & report

93000
Flagged

Medical necessity may not be supported

BCBS LCD L33393 indicates that routine ECG (93000) requires documented cardiac symptoms or cardiovascular risk factors for E11.9 (Type 2 Diabetes). The submitted clinical notes mention chest tightness — verify this is documented in the patient record before confirming.

Why these codes were suggested

Based on diagnosis E11.9 (Type 2 Diabetes) and the procedure description, ClaimClear matched an established-patient office visit (99213) and a routine ECG (93000). These are the most common codes for this combination. Always verify against clinical notes and payer guidelines.

CPT code selection is the billing administrator's responsibility. Suggestions do not constitute coding advice.

Insurance Entry

Step 2 of 3 — Verify coverage details

PATIENT INSURANCE

Has insurance
Blue Cross Blue Shield (BCBS)
Commercial PPO
XYZ-789456123
20%

PAYER RULE NOTE

BCBS Commercial PPO requires prior authorization for stress tests (CPT 93015) when ordered with an office visit. Confirm PA status before generating estimate.

Submitted

Estimates sent to patients this period

SENT THIS WEEK

23

4 vs last week

AVG. ESTIMATE RANGE

$280

Midpoint this week

PORTAL OPENS

18

Patients viewed estimate

RECENT SUBMISSIONS

#4821

Patient A

99213 · 93000 · Dr. Rivera

Today, 9:47 am Sent
#4819

Patient C

99201 · 71046 · Dr. Kim

Today, 9:02 am Sent
#4817

Patient E

99395 · Dr. Okafor

Yesterday Sent

Denials

Claims flagged or denied by payers

OPEN DENIALS

3

Require response

APPEALED

15

12 successfully appealed · 3 in progress

RESOLVED THIS MONTH

12

5 overturned

OPEN DENIALS

#4810

Patient J

93015 — Prior auth missing · Aetna HMO

CO-4
#4805

Patient K

99215 — Not medically necessary · UHC PPO

CO-50
#4798

Patient L

80053 — Duplicate claim · Cigna

CO-18

Code Lookup

Search CPT, ICD-10, and HCPCS codes

COMMON CODES — INTERNAL MEDICINE

5 codes
99213

Office visit — established patient, moderate complexity

E&M · Level 3

93000

Electrocardiogram, routine ECG with at least 12 leads; with interpretation & report

Cardiology

99214

Office visit — established patient, moderate-high complexity

E&M · Level 4

80053

Comprehensive metabolic panel (CMP)

Laboratory

99395

Periodic comprehensive preventive medicine — established patient, 18–39 years

Preventive

Payer Rules

Coverage policies and prior auth requirements by insurer

BCBS — BLUE CROSS BLUE SHIELD

93015

Stress test — prior authorization required when billed with office visit

Updated Jan 2026

PA Required
99213

Office visit — no prior auth required for established patients

Updated Mar 2025

No PA
93000

ECG — covered without PA when ordered by cardiologist or PCP

Updated Mar 2025

No PA

AETNA HMO

93015

Stress test — always requires prior authorization

Updated Feb 2026

PA Required

Audit Log

All actions logged for HIPAA compliance

JUNE 5, 2026

9:47 am J. Lee Sent estimate to patient via portal #4821 Sent
9:32 am J. Lee Reviewed estimate — approved for sending #4821 Reviewed
9:14 am J. Lee Generated estimate #4820 Generated
9:02 am M. Obi Sent estimate to patient via portal #4819 Sent
8:47 am J. Lee Reviewed request — flagged missing insurance info #4818 Flagged
8:31 am S. Park Opened patient record #4815 Viewed
8:10 am J. Lee Logged in — Auth

All actions are time-stamped and tamper-evident. Log retained for 7 years per HIPAA requirements.

Settings

Account, notifications, and workspace preferences

Profile
Notifications
Access & Roles
Integrations
Billing

PROFILE

JL

J. Lee

Junior biller · Internal Medicine

Jamie Lee
j.lee@clinic.org
Junior biller (read-only assignment)
Internal Medicine

NOTIFICATIONS

New estimate request assigned

Alert when a doctor submits a new request for you

Estimate sent confirmation

Confirm when patient receives estimate via portal

Denial alert

Notify when a payer denies a claim

About ClaimClear

Version, legal, and product information

Claim Clear

Transparent cost estimates for patients, built for healthcare billing teams.

VERSION

1.0.0-beta

LAST UPDATED

June 2026

ENVIRONMENT

Internal prototype

WHAT CLAIMCLEAR DOES

ClaimClear helps clinics get billing right before a patient even walks in the door. When a doctor submits a request, ClaimClear reads the notes and suggests the appropriate billing codes — then automatically flags anything that might cause a problem with insurance, so the billing team can sort it out upfront instead of dealing with rejected claims later.

It also sends patients a simple cost estimate before their appointment, based on those same CPT codes, in plain English. Along with the estimate, patients get a short list of questions to ask their insurer — because coverage rules are complicated and even a clean claim can come back differently than expected. The goal is to give patients enough information to advocate for themselves before the bill arrives.

01Billing staff review doctor-submitted requests and assign CPT codes
02Insurance coverage details are entered and verified
03A plain-language estimate is generated and reviewed
04The estimate — including a list of questions for their insurer — is delivered to the patient via the patient portal

COMPLIANCE & LEGAL

All actions are logged for HIPAA compliance. Cost estimates are informational only and do not constitute a guarantee of benefits. Patients are advised to verify coverage with their insurer.

© 2026 ClaimClear · Internal use only · Not for distribution