Capture data once at the source and propagate it, eliminating errors and missed opportunities.
The anesthesiologist signs a structured attestation before leaving.
Clomr crosswalks the surgical CPT, computes time units, derives the direction modifier from the attested rooms, scrubs against eligibility and the NCCI edits, and files the 837P.
anesthesia start 07:42
anesthesia end 09:18
------
elapsed 96 min
96 / 15 = 6.4 time units
base (00790) = 7.0 base units
------
total = 13.4 units
$97.50 per unit = $1,306.50 expected
| AA | Personally performed by the anesthesiologist. |
| QK | Medically directed, two to four concurrent procedures. |
| QX | The CRNA line, with medical direction by a physician. |
| QZ | CRNA service without medical direction by a physician. |
Clomr posts the 835 line by line and flags anything that paid under contract.
| Line | Billed | Allowed | Adjustment | Paid | Patient |
|---|---|---|---|---|---|
|
00790 · P2 · QK
13.4 units · physician line
|
$1,742.00 | $1,267.50 |
$474.50
CO-45 contractual
|
$1,014.00 |
$253.50
PR-2 coinsurance
|
|
Contract check
13.4 units at $97.50
|
– | $1,306.50 | expected per contract | – | Short $39.00 |
Meridian priced 13.0 units. The contract pays in tenths: $39.00 on this claim, and a policy across every case.
Every denial resolves into one of two problems.
Billed in a way this payer will not read. An agent corrects it from the attestation, re-scrubs, and refiles inside the window.
Billed right, and the payer disagrees anyway. A named person takes it, with the evidence already attached.
| Code | What the payer is saying | What Clomr does about it |
|---|---|---|
| CO-16 | The claim lacks information. | The remark code names a field the attestation already holds. |
| CO-4 | The modifier is inconsistent with the procedure code. | The room-by-room timeline shows which side has it wrong. |
| CO-97 | The benefit is bundled into another service. | Concede the bundle, or appeal with the times that show two events. |
| CO-50 | Not deemed a medical necessity. | Never handled by an agent. It goes in front of a person. |
| CO-29 | The filing limit has expired. | The 999 and the 277CA are your proof of timely filing. |
An agent assembles the argument from the attested record and drafts the letter.
Meridian denied the anesthesia line with CARC CO-4. Their Anesthesia Services policy, §4.2, permits modifier QK for two to four concurrent procedures. The attestation signed at 09:21 records two rooms with the attending present at induction and emergence in each.
We request reconsideration and payment of $1,306.50.
One rule per stage. You can always ask for more human review.
| The agent does | A person decides |
|---|---|
| Capture | |
| Pre-fills the case and holds it open for attestation. | Whether the case as attested is what happened. |
| Coding | |
| Crosswalks the CPT, computes time, derives the modifier. | Any call the attestation leaves ambiguous. |
| Scrub and submission | |
| Runs eligibility and payer edits, files, reconciles the 277CA. | Whether to file a claim the scrub held. |
| Posting | |
| Posts the 835 line by line and flags the variance. | Whether a variance is payer error or a rate to renegotiate. |
| Denials | |
| Classifies the denial, clusters by root cause, corrects and refiles. | Write off, appeal, or call the representative. Necessity, always. |
| Appeals | |
| Drafts the letter, assembles the exhibits, tracks the deadline. | Every appeal that leaves the building. |
Send us one facility PDF and last month’s case claims data. We return the leakage rate and where it came from.