Claims

Domain: Billing & Finance | Type: Custom (active)

Full reference: CRM Modules Guide

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What is it?

Insurance claims module. Tracks claims submitted to insurance payers on behalf of patients for clinical services rendered.

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Claims Lifecycle

Encounter completed (SOAP notes, CPT/ICD-10 codes)
    → Claim created
    → Submitted to insurance payer
    → Payer adjudicates (approved / denied / partially paid)
    → EOB received
    → Payment posted to Invoice
    → Balance billed to patient (if any)

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Key Fields

Field	Description
Patient	Linked Contact record
Encounter	Clinical visit the claim is for
CPT Codes	Procedure codes billed
ICD-10 Codes	Diagnosis codes
Payer	Insurance company
Status	Submitted, Adjudicated, Denied, Paid
Amount Billed	Total billed to payer
Amount Paid	What payer paid
Patient Responsibility	Remaining after insurance

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Insurance vs Cash Patients

ThriveLab serves both insurance and cash-pay patients:

Patient Type	Claims Used?
Insurance	Yes — claim submitted per encounter
Cash / Membership	No — Invoice generated directly

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Related Modules

• Encounters — Each claim tied to an encounter with CPT/ICD-10 codes
• Invoices — Payment posted; patient responsibility invoiced
• Contacts — Claim linked to patient
• Patient Plans — Plan type (Insurance layout) determines claim workflow

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Full reference: CRM Modules Guide