When does the Readiness Check run?

On step 1 (Select) of the CMS-1500 Simple wizard, automatically, as soon as you pick a patient and tick at least one visit. It re-runs every time you tick or untick a visit, switch patients, or save an inline fix.

Why is Next disabled?

At least one of the five Readiness Check rows is failing. Expand every row marked N missing, fill the missing fields inline, click Save, and watch each row turn green. Next activates the moment the last row passes.

Can I override or skip the Readiness Check?

No. There is no override path. Every required CMS-1500 segment must pass before the wizard advances. This is to prevent shipping a claim that is guaranteed to be rejected at the clearinghouse for missing structural data.

Does the Readiness Check show errors or warnings?

It shows blocking checks only, not advisory warnings. Every yellow N missing row is a hard fail. A green check row is a hard pass. There is no middle warning state in the panel.

What about payer-specific validation?

The Readiness Check on step 1 only audits the structural CMS-1500 segments (patient demographics, providers, insurance, facility). Payer-specific edits (procedure code allowed at this place of service, diagnosis code valid for this payer, and so on) live downstream at your clearinghouse and eventually at the payer. AveeCare surfaces those rejections on the Claims tab once they come back.

Where do the field values get saved when I click Save inline?

Inline saves write straight to the underlying record. A Billing Provider Address save lands on the Company record. A Rendering NPI save lands on the caregiver. A patient address save lands on the patient. Every claim for that patient, caregiver, or company benefits from the fix going forward.

How does this differ from Pre-Billing QA?

Pre-Billing QA is a separate page that checks per-visit clinical readiness (notes signed, ADLs charted, EVV captured). It runs upstream and catches issues earlier. The Readiness Check on the CMS-1500 wizard is structural and runs at claim build time. They are complementary, not redundant: a visit can be Pre-Billing QA clean and still fail the Readiness Check if, for example, the company NPI is blank.

Auto-validate before submit

AveeCare auto-validates every CMS-1500 claim on step 1 of the Simple wizard. A Readiness Check panel at the bottom of the Select step audits five CMS-1500 segments against the patient, company, caregiver, and visit records, and disables the Next button until every required field is filled. You fix missing fields right from the panel without leaving the modal.

Quick answer

Open Billing, click the small blue shield icon on a visit row, and scroll the modal down to the Readiness Check. Each row is either green (passed) or yellow with N missing. Click a yellow row to expand it, fill the missing fields inline, click Save, and the row turns green. Once all five rows pass, Next activates and you can continue to Clinical and Review.

Open Billing

What the Readiness Check audits

The panel runs five checks for every claim:

Patient Demographics. First and last name, date of birth, gender, street address, city, state, and zip on the patient record.
Billing Provider. Company NPI, Tax ID, taxonomy code, and the company business address (street, city, state, zip).
Rendering Provider. One row per caregiver assigned to a ticked visit. Each rendering row is gated on that caregiver's NPI.
Insurance Info. Payer ID, member ID, and payer name on the patient's Insurance tab.
Service Facility. Facility name, address, and NPI on the company record.

Rows that pass show a green check on the left. Rows that fail show a yellow triangle and the count of missing fields on the right (for example, 5 missing). The Next button at the bottom of the modal stays disabled until every row passes.

1. Open the CMS-1500 wizard from a visit row

Click Billing in the left nav and scroll the Visit Billing table right.
The shield icon lives in the Actions column at the far right of Visit Billing. On a 1080p screen you may need to scroll the table horizontally to expose it.
Click the small blue shield icon on a row whose patient has insurance.
The hover tooltip reads Generate insurance claim (837P). Rows without an insurance record on the patient do not show this icon. The CMS-1500 Professional Claim (837P) modal opens on the Simple tab at step 1, Select.

2. Read the Readiness Check panel

Scroll the modal down past the Visits list to the Readiness Check panel.
The panel only renders after a patient is selected and at least one visit is ticked. Visits are usually preselected from the row you clicked, so the panel is typically visible on first open.
Scan the five rows and identify which segments are failing.
Passing rows are green. Failing rows are yellow with a count like 5 missing. The count is the number of required CMS-1500 fields on that segment that are still blank.

3. Fix missing fields inline and click Save

Click a failing row to expand the inline fix form.
The row opens into a yellow-tinted panel listing one input per missing field. For Billing Provider, the typical missing set is Taxonomy Code, Address, City, State, and Zip Code on the company record.
Type values into every input and click Save.
Inline saves write straight to the underlying patient, company, caregiver, or visit record. They persist across sessions, so the next claim for this patient will not have to fix the same fields again.
Watch the row collapse and turn green after Save completes.
If a value is rejected (for example, a non-numeric Zip Code or a Tax ID with letters), the row stays yellow and the offending field gets a red border. Fix and click Save again.

4. Confirm Next activates and continue the claim

When every row has a green check, the Next button activates.
Until then, Next is greyed out and unclickable. This is the gating behavior: there is no override, no skip, no “submit anyway” option. Every required CMS-1500 segment must pass before the wizard advances.
Click Next to walk to Clinical, then Review, then submit.
The Readiness Check only runs on step 1 of the Simple wizard. Clinical and Review trust the data on step 1. If you need to go back and change a value, click step 1 in the wizard header and the Readiness Check re-evaluates.

Common pitfalls

Next stays disabled even after Save. A row only turns green when every missing field on that segment has a value. If you filled four out of five inputs and clicked Save, the row still shows 1 missing. Re-expand and fill the last input.
Rendering row shows “No caregiver assigned.” One of the ticked visits has no caregiver. Untick the unassigned visit, assign a caregiver on Scheduling first, or open the visit and set a rendering provider before returning to the wizard.
Insurance Info row will not turn green. The patient has an Insurance tab entry but it is missing payer ID, member ID, or payer name. Open the patient's Insurance tab in a separate browser tab, fill the missing field, save, then return to the wizard and re-click Insurance Info to refresh.
Billing Provider keeps failing in bulk. The same company-level fields (NPI, Tax ID, taxonomy, business address) feed every claim. Fix them once on the Company settings page and the row turns green for every future claim too.
The inline form does not have every box you expected. The inline form only lists fields that are actually missing. If a field is already filled on the source record, it does not appear in the fix form. That is by design, not a bug.