Generate claims, submit to clearinghouses, and get paid by insurance.
AveeCare handles the full insurance billing workflow: CMS-1500 form building, EDI file generation (837P, 837I), eligibility verification (270/271), claim status checks (276/277), and clearinghouse integration — so you spend less time on paperwork and more time on care.
Build CMS-1500 claims in minutes, not hours
The CMS-1500 is the standard paper form used to bill insurance for professional services. AveeCare lets you fill it out digitally with two modes, depending on your experience level.
Simple Wizard
A step-by-step guided experience. Perfect for agencies new to insurance billing or staff who don't submit claims every day.
- Walks you through each section one at a time
- Auto-populates patient demographics from their profile
- Pulls visit dates, times, and service codes from completed visits
- Fills in your agency NPI, taxonomy code, and provider info
- Prompts you for diagnosis codes with a searchable lookup
- Validates required fields before letting you proceed
Advanced Form
All 33 CMS-1500 boxes exposed on a single screen. Built for experienced billers and claims specialists who need full control.
- Every CMS-1500 field visible and editable at once
- Tab between boxes like a physical form — but faster
- Override any auto-populated value when needed
- Add multiple service lines with individual modifiers
- Set rendering, referring, and billing provider independently
- Attach supporting documentation directly to the claim
Auto-Fill & Output Options
Both modes share an Auto-Fill button that pre-populates the form from existing patient and visit records. Once your claim is ready, you can:
Generate X12 File
Download the 837P/837I EDI file for manual clearinghouse upload
Submit to Clearinghouse
Send directly via SFTP to your connected clearinghouse
Generate PDF
Create a printable CMS-1500 PDF for your records or mail submission
Print CMS-1500
Print a filled CMS-1500 on red-ink paper for legacy payers
EDI transactions in plain language
EDI (Electronic Data Interchange) is how healthcare providers and insurance companies talk to each other electronically. Here are the transaction types you will encounter, explained without jargon.
837P
Professional Claims
What it is
The electronic version of a CMS-1500 form. It contains everything an insurance company needs to process your claim: patient info, diagnosis codes, procedure codes, and provider details.
When you use it
Every time you want to get paid by insurance for a caregiver visit. This is the form type you will use the most.
In AveeCare
Click "Generate 837P" on any validated claim. AveeCare builds the X12 file automatically from your visit and patient data. Download it, or submit directly to your clearinghouse.
837I
Institutional Claims
What it is
The institutional counterpart to 837P. Instead of billing for individual provider services, this bills at the facility or organization level using a UB-04 format.
When you use it
When your agency bills as an institution rather than under individual provider NPIs. Less common in home care, but needed for certain Medicare arrangements.
In AveeCare
Toggle between Professional and Institutional claim types when generating. AveeCare maps the correct fields for each format automatically.
270/271
Eligibility Verification
What it is
A two-part transaction. You send a 270 (the question: "Is this patient covered?") and get back a 271 (the answer: coverage details, deductibles, copays, and benefit limits).
When you use it
Before providing service. Checking eligibility upfront prevents claim denials and lets you inform patients about their out-of-pocket costs.
In AveeCare
From a patient profile, click "Verify Eligibility." AveeCare sends the 270, parses the 271 response, and displays coverage details in plain language — no reading raw EDI.
276/277CA
Claim Status
What it is
After you submit a claim, you can check its status. Send a 276 (the question: "Where is my claim?") and receive a 277CA (the answer: accepted, pending, denied, or paid).
When you use it
When a claim has been submitted but you haven't received payment yet. Use it to follow up without calling the payer.
In AveeCare
Click "Check Status" on any submitted claim. AveeCare sends the 276, reads the 277CA response, and updates the claim status badge automatically.
835
ERA / Remittance
What it is
The electronic Explanation of Benefits (EOB). It tells you exactly what insurance paid, what was adjusted (and why), and what the patient still owes.
When you use it
After a claim is processed and the payer sends back payment information. This is how you reconcile what you billed vs. what you received.
In AveeCare
AveeCare imports 835 files, auto-matches payments to your submitted claims, and flags discrepancies. Covered in full on the ERA & Remittance page.
999
Acknowledgment
What it is
A simple receipt from the clearinghouse confirming they received your file. It does not mean your claim is accepted or will be paid — just that the file arrived and was syntactically valid.
When you use it
Immediately after submitting a claim file. If you do not receive a 999, your file may not have been transmitted successfully.
In AveeCare
AveeCare automatically checks for 999 acknowledgments after submission and updates the claim status from "Submitting" to "Submitted" once received.
Generate all your claims at once
Instead of generating one claim file at a time, batch mode lets you select multiple validated claims and combine them into a single X12 file for submission.
How batch claiming works
Filter claims by date range, payer, or status to find all pending claims
Select individual claims or click "Select All" to include everything
Click "Batch Generate 837P" to combine all selected claims into one X12 file
Download the file and upload it to your clearinghouse portal, or submit directly if connected via SFTP
Good to know: Batch generation performs the same validation checks as individual claims. If any claim in the batch has errors, it will be flagged and excluded — the rest of the batch still generates successfully.
Connect to your clearinghouse
What is a clearinghouse?
A clearinghouse is a middleman between your agency and insurance companies. It takes the EDI claim files you generate, checks them for errors, translates them into the format each payer requires, and routes them to the correct insurance company. When the payer responds (with a status update, denial, or payment), the clearinghouse sends that response back to you.
Think of it like a postal service for claims: you drop off your mail (claims) at one place, and they sort and deliver it to hundreds of different destinations (payers) — and bring back the replies.
Supported Clearinghouses
Availity
Largest free clearinghouse. Covers most major payers.
Trizetto (Cognizant)
Strong payer connectivity. Popular with larger agencies.
Office Ally
Budget-friendly. Good for smaller agencies getting started.
Optum
UnitedHealth Group's clearinghouse. Deep UHC integration.
Waystar
Advanced analytics and denial management. Enterprise-grade.
Need a different clearinghouse? Contact us
SFTP Connection Setup
Enter your clearinghouse SFTP credentials (host, port, username, key or password) in AveeCare settings. We securely store them and use the connection to send claim files and poll for responses. Setup takes about two minutes.
Direct Submit & Response Polling
Once connected, click "Submit to Clearinghouse" on any claim or batch. AveeCare uploads the file via SFTP, then periodically checks for response files (999 acknowledgments, 277CA statuses, 835 remittances) and updates your claims automatically.
Track every claim from draft to payment
Every claim in AveeCare has a status badge that updates as it moves through the billing pipeline. Here is the full lifecycle:
Draft
Claim created, not yet validated
Validated
All required fields confirmed
Submitting
Being sent to clearinghouse
Submitted
999 acknowledgment received
Acknowledged
Payer confirmed receipt
Accepted
Claim approved for payment
Paid
835 remittance received
Draft
Claim created, not yet validated
Validated
All required fields confirmed
Submitting
Being sent to clearinghouse
Submitted
999 acknowledgment received
Acknowledged
Payer confirmed receipt
Accepted
Claim approved for payment
Paid
835 remittance received
Denied or Rejected
Can occur after the Accepted stage
If a payer denies or rejects a claim, its status updates with a red badge and the denial reason codes. From there, you can edit the claim, fix the issues, and resubmit — all without starting over. See the Handling Rejections section below.
Fix and resubmit denied claims in minutes
Claim rejections happen. What matters is how fast you can identify the problem, fix it, and get the claim back out the door.
The rejection workflow
Spot the rejected claim
Rejected and denied claims show a red badge in your claims list. Filter by status to see all rejections at a glance.
Read the reason codes
Click the badge to see the denial reason codes returned by the payer, translated into plain English. Common reasons: missing modifier, invalid diagnosis code, authorization expired, duplicate claim.
Edit the claim
Click "Edit & Resubmit." The CMS-1500 form opens pre-filled with all the original claim data. Make your corrections — fix the diagnosis code, add the missing modifier, update the authorization number.
Resubmit
Save your changes and submit again. AveeCare generates a new X12 file with the corrected data and sends it to your clearinghouse. The claim status resets to "Submitting."
Download reference files
Need to review the raw data? Download the original outgoing EDI file and the payer's response file for your records or for escalation to the clearinghouse.
Ready to simplify insurance billing?
See how AveeCare handles CMS-1500 forms, EDI generation, and clearinghouse submissions — try it free in the interactive demo, no sales call required.