Guides

What is billed and when for each product, the prices and the monthly minimum, how the billing month works, and how to read your usage, statements and CSV; test mode is never billed.

Claim House bills per transaction. Every check, claim, attachment and ERA writes a usage record saying whether it is billable and why; a month's usage priced by your agreement is what you see on the Usage & billing screen, in GET /usage and on your statements. Nothing is collected through Claim House yet: a statement is a document, not a charge.

What is billed and when#

Each product's own rules decide when a record is billable, once, when the record is written. Pricing never changes that decision; it prices the counts.

• Eligibility & benefits. A check is billed when the payer answers it, or rejects it because of the member, the provider or the request (such as “not found”). It is free in test mode, when the payer is down or rejects it for a reason the caller could not fix (the payer’s own, or the request Claim House built), when Claim House could not complete it, and when a recent answer is reused.
• Electronic claims. A claim is billed once, when its file is handed over to the network. It is not billed in test mode, when it is rejected before it is sent, or when the network would not take its file; a correction sent again, or a claim sent again after its file was rejected, is not billed a second time. A void is a claim of its own, billed once when it is sent, and a predetermination is billed like a claim.
• Electronic attachments. An attachment is billed once, when it is closed and gets its number. It is not billed in test mode.
• ERAs (835 remittances). An ERA is billed once for each remittance received. It is not billed in test mode, or when it carries only a predetermination’s estimates (the predetermination was billed when it was sent).

The reasons behind each record, as they appear in the API (reason) and on the screen:

Prices#

These are the standard prices. An agreement may carry a rate card of its own, and the Usage & billing screen and the API always show the rates in force for you.

Eligibility checks are priced in tiers, counted across your whole organization for the billing month, in the order the checks became billable:

Amounts are worked out from the exact rate and rounded to the cent once, on each line of the statement (half a cent rounds up). In the API every amount is a decimal string of dollars, such as "76.50".

The monthly minimum#

Your amount due for a month is the greater of the month's fees and your monthly minimum: $1,000.00 a month, or $500.00 in each of the first 3 months live. The first 3 months are counted from the month your organization first went live. The screen and the API say which one applied (minimum_applied).

The billing month#

A billing month is a calendar month in America/Denver (Mountain time) for every partner, so a transaction a second before midnight there belongs to the month that ends. The month, its time zone and the state of the month are on every answer: open means the month is computed from the usage records as of now; issued means it has been closed and is read from its statement, which never changes. Usage dated in a closed month that is recorded after its statement was issued goes on the next statement as an adjustment line: what it adds to what that month owed, or no amount when that month's minimum absorbs it (the line says so). Late records that are none of them billable get no line. A month that has not begun has no figures: asking for one answers 422 with invalid_value on month.

Statements#

A month is closed once it has ended. Its statement has a number (ST-<yyyymm>-<your organization ID>), is issued on the 1st and is due 15 days later. GET /statements lists them and GET /statements/{id} shows one with its lines. A month is billed, and owes the minimum, only when your organization was live during it: a month before you went live, or after you left live, owes nothing and shows billing: "pre_production" and live: false. If you leave live during a month, that month is billed and the next is not; a return to live bills from the month you return in.

curl "https://sandbox.myclaimhouse.com/api/v1/statements?limit=12" -H "Authorization: Bearer $CLAIMHOUSE_KEY"

Read your usage#

GET /usage answers for the current billing month, or for month=YYYY-MM: for each product the billable count, the transactions not billed with the reason for each kind, the rate and the amount, each eligibility tier, the fees, the minimum and the amount due.

curl "https://sandbox.myclaimhouse.com/api/v1/usage" -H "Authorization: Bearer $CLAIMHOUSE_KEY"

GET /usage/units lists the records the figures are counted from, oldest first, one per transaction: the time, the product, the ID of the resource, whether it is billable and why, and for a billable check the price of its place in the tiers. A record carries no patient data. Filter by product and billable; page with cursor.

curl "https://sandbox.myclaimhouse.com/api/v1/usage/units?product=eligibility&limit=25" -H "Authorization: Bearer $CLAIMHOUSE_KEY"

On the Usage & billing screen, Download usage CSV gives the same records of the chosen month, one row each (time, product, resource_id, billable, reason, tier_price), for the mode you are viewing. The file starts with a UTF-8 byte order mark so spreadsheets read it correctly.

Test mode is never billed#

A test key sees test activity only, in the same shapes: the figures count what you did in the sandbox, and nothing is priced (billing: "test_activity", amount_due: "0.00"). A test key sees no statements.

To be confirmed#

These are decisions the Claim House owner has not confirmed yet; the figures above follow the current settings.

• The billing time zone (America/Denver) is to be confirmed.
• What counts as billable for a claim (once, when its file is handed to the network; a void as its own unit) is to be confirmed.
• Whether test activity should ever be invoiced is to be confirmed. Today it never is.
• Adjustments for late usage are added to the next statement's amount due; the exact treatment is to be confirmed.