<aside> 📅

Last updated May 29, 2025.

</aside>

<aside> 💡

Please see Integration Overview for a more comprehensive view of how the claim flow works with Goodbill.

</aside>

Overview

We’re able and willing to do any sort of customization you may need in order to pass back the appropriate 837 modifications that make the most sense for your system.

That said, with dozens of implementations under our belt, these are the most common modifications we offer and turning them on for testing can take just a few hours.

<aside> 💡

Because claims are generally returned at various different times, expect no claims to come back in a batch. Though possible, it is extremely unlikely to see more than one claim per file.

</aside>

837 Return Cases

We have 3 distinct types of modifications that can occur with an 837 (called Return Cases):

• deny the claim
• reprice the claim due to edits or 501(r)
• do not reprice the claim as it is clean or ineligible for 501(r)

<aside> ⚠️

Some partners’ systems are designed to allow the same claim to be returned twice. In other systems, though, a claim may only be returned one time.

In the case of a system that only allows a single response for a claim, we generally “resubmit” the claim as a new claim, with a different sender ID. This allows the partner’s system to ingest this second, repriced claim, and be matched to the original (denied) claim.

</aside>

Denial

This is sent back when a 501(r) application is in progress and, in order for the hospital to approve or deny the application, the claim must be denied to the provider.

When will this happen?

• When an eligible claim’s member is screened eligible for 501(r) or a 501(r) application is submitted.

What does the partner do next?

• Denies the claim to the provider.
• Expect a second claim at a later date.