Medical billing, rebuilt on modern foundations
ClaimPod is a medical-claims platform for billing teams and the practices they serve. It takes the visit data your clients generate, builds clean claims from it, routes anything that needs human judgment into work queues, and produces claim files ready to send to insurance payers so you can get paid easier and faster.
Medical billing deserves a fresh build
Much of the billing software running today was designed decades ago, and it shows: bolted-on features, workflows shaped by old constraints, and teams paying for it in denials, slow payments, and busywork. We think the honest fix is not another layer on top - it's a fresh build on a modern technology base.
So that's what ClaimPod is, built in the order that matters and solid foundations:
Audit Trail
Every change captured at the database itself - append-only, for every role, with reads of patient data logged too. Exportable as CSV, with SSNs and provider tax IDs recorded as their last four digits only.
Access Control
Roles and per-client permissions from day one, so people see exactly the accounts they work. Only a Superadmin can grant Administrator or change a Superadmin's account.
Client Isolation
Each client's data is partitioned in its own space - no cross-tenant leakage by construction.
Modern Tech Base
Built on current technology, not a decade of features bolted onto an old core. Filing a claim batch takes the same few database writes at any size, and no release reaches the demo before the full test suite passes.
One loop, from raw file to posted payment
Six steps, one flow. Clean work moves straight through - people only touch what a rule flags. The steps walk themselves - click any one to take over.
EDI, CSV, or HL7 files load through mapping templates - set up once per source.
Every row validates in staging first. Problem rows stop for a human review.
Claims are built from clean visit data - never typed in - and scrubbed by rules.
Ready claims batch into an 837P file with proper control numbers, or print onto CMS-1500 forms for the payers that still take paper.
Clean payments post automatically. Anything odd is held for a person.
What the payer left to the patient goes out as a statement - held if nobody may bill them, and the collections clock starts the day you say the envelopes went out.
EDI, CSV, or HL7 files load through mapping templates - set up once per source.
What works, what's in progress, and what's next
ClaimPod is in development: we build in three phases toward one complete product, and every improvement ships to the live demo the moment it lands - what you see there is never months behind the code.
Platform Foundation
The platform stands: architecture and runtime, identity and access with roles and per-client permissions, and the trust substrate - audit trail and clinical reference data. Compliance built in from the start, not retrofitted.
Core Billing Loop
The complete billing process, end to end: collect data → review → generate claims → file → post remittances → work denials → bill the patient. This is where we are now - the loop runs end to end in the demo, and each pass through it gets deeper.
Competitive Edge
Depth, automation, and AI on top of the working loop: payer-specific edits like NCCI/MUE, coordination of benefits, appeals, underpayment detection, patient financial tools, and the pre-encounter front office. Reporting came early, because clients asked for the numbers before the depth.
Working in the demo today
17- Data Imports
EDI 837/835, CSV, and HL7 v2 files load through reusable mapping templates - staged and validated before anything touches live data. A multi-claim 837 keeps every claim's own subscriber and payer, dependents included.
- Import Review
Rows with problems stop in a workspace showing what the file said, what matched, and exactly what conflicts.
- Claim Generation & Scrub
Claims are built from visit data and checked by review rules; clean ones promote themselves without a human opening them. A service that arrives without a charge is priced from the practice's own dated fee schedule, and one with no price on file holds its visit instead of billing $0.00.
- Claim Filing, Electronic and Paper
Ready claims batch into a real 837P file with per-client control numbers, or print onto CMS-1500 forms for the payers that still take paper. Either way, filing is what marks the claim submitted.
- Remittance Posting
835 payments post automatically when clean; anything anomalous is held for a reviewer instead of silently booking money.
- Secondary Claims
When a primary payment leaves a balance the patient's secondary coverage should pay, ClaimPod moves it onto a secondary claim it creates for you, filed electronically with the primary's payment details or on paper with an adjudication page. A takeback on the primary voids an unsent secondary, or opens a work item for one already filed.
- Patient Billing
Statements are generated from what the ledger says the patient owes, held when nobody may bill them, and sent as a print batch. The collections clock starts from the day you say the envelopes went out, not the day the file was made.
- Printed Documents
Statements and claim forms are configured, versioned and activated per client. Every document records the version that drew it, so a reprint matches what was mailed.
- Rules Engine
One catalog of rules triggered at different points - on import, at claim review, when a remittance lands. Authored as data, editable and switch-off-able per client, with a dry run before any rule goes live.
- Work Queues
Review workspaces on one shell - import, claim, remittance, statement, and follow-up - each working one item at a time, each recording the decision on the record.
- Bulk Actions
Select a page, hand-picked rows or everything matching a filter (up to 5,000) and act on them at once: check, file, print, revert or delete claims, switch rules on or off, export to CSV or Excel. Every run is tracked record by record, with a retry for the ones that failed.
- Record Activity
Every patient, claim, visit and remittance keeps one feed, newest first: the notes your team writes beside what ClaimPod recorded on its own - decisions, claim status changes, finished work items, balances moving between payers. A pinned note shows as a banner on the record and its work items.
- Reporting
A/R aging, denial analysis, clean-claim rate, payer scorecards and the rest of the catalog, runnable on demand or delivered on a schedule.
- Audit Trail
Every change captured at the database itself - append-only, for every role, with reads of patient data logged too. Exportable as CSV, with SSNs and provider tax IDs recorded as their last four digits only.
- Sign-In & Connection Security
Five wrong passwords lock an account for 15 minutes, and guesses from elsewhere can't shut the owner out: the right password still works on a device they signed in from in the last 30 days. Sessions end after 30 idle minutes or nine hours, and changing a password signs out every other device. A saved connection password is only sent to the destination it was saved for, and SFTP and S3 connections can't reach private network addresses unless the installation allows it.
- No Silent Overwrites
When two people edit the same record, the second save is refused and offered a Reload to see the other person's change, so nobody's work is overwritten without them knowing.
- Everyday Usability
Clickable table rows open with Enter, pickers clear from the keyboard, every page names itself in the browser tab, and screens skip redrawing what hasn't changed.
In progress
5- Remittance Review
Broad processing of every incoming remittance: rules sort them by exception - denials, short pays, recoupments, credit balances - and the decision is recorded on the record. Entering a paper EOB by hand is still to come.
- Payment Posting
The posting engine runs: adjustments by reason code, the patient's share held as patient A/R instead of vanishing as a write-off, and corrections when money posted wrong. A takeback reverses only the payment it matches, anything ambiguous is held for a biller, and voiding a claim keeps the patient's own payment as credit. Still to come: takebacks a payer applies to a whole remittance instead of one claim, and posting metrics.
- Taking Patient Payments
The ledger already accepts a patient payment and allocates it oldest first; what is missing is the screen a biller posts it from.
- Analytics
The overview answers where the money is and what needs attention before you open a single claim; the day-to-day dashboard is still being widened.
- AI Assistance
Today it drafts an import mapping from a sample file's column names alone - no patient data is sent - and a person reviews it before it is saved. More suggestions will follow the same rule: never deciding silently.
Next steps
6- Payer-Depth Edits
NCCI/MUE bundling checks, tertiary-payer coordination, and structured appeals.
- Eligibility & Acknowledgments
270/271 coverage checks before care, 277CA responses after filing, so a claim's fate is known without asking.
- Clearinghouse Integration
Files already leave ClaimPod on their own - pushed to a connection you configure, or straight to a printer. What is next is speaking each clearinghouse's dialect and reading what it sends back.
- Patient Financial Tools
Payment plans, estimates before care, and the self-pay path around them.
- Multi-Factor Sign-In
A second step at sign-in, such as a code from an authenticator app, on top of the password and lockout protection already in place.
- Deeper Automation
More of the clean path handled end to end, so even less routine work reaches a person.
These are ideas, not promises - and the list is open. If something here is what you need first, or something is missing entirely, tell us: the roadmap is shaped by exactly these conversations.
The team behind ClaimPod
Four co-founders with software engineering, product, and healthcare experience, building as UAB "Baium Software" in Vilnius, Lithuania.
Ten years of backend engineering across banking, ERP, and medical billing products - as a developer and a team lead. After a decade of building other people's software, ClaimPod is the product he decided to build for himself.
A developer who turned his focus to DevOps. Built for banking products and large ERP platforms; now he makes teams ship faster - and makes sure what they ship stays up and scales.
The demo says it better than we can
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