SharpRCM: Billing and Practice Management

SharpRCM is where you build claims. Patients, encounters, coding, fee schedules, payer contracts, claim creation, and payment posting all live here, inside the same ClaimRev portal you already use for claim submission.

Your billing team works directly in SharpRCM. Claims they create are submitted through ClaimRev's clearinghouse, and payments come back to the same place.

ClaimRev has three pieces that are easy to mix up. You may use one, two, or all three.

If you use SharpRCM, you are also using the clearinghouse, because that is how your claims reach payers.

Set these up once, roughly in this order. Later steps depend on earlier ones.

1. Practice: your practice record and its defaults.
2. Providers: everyone who renders or bills, with their NPI, taxonomy, and other identifiers.
3. Facilities: your locations, with place of service.
4. Payers: the insurance companies you bill.
5. Payer contracts and fee schedules: your contracted rates. These can drive pricing automatically when a claim is built.
6. Procedure codes: the CPT codes you use, with fees and any time-unit mappings.
7. Telehealth rules, if you bill telehealth. These apply the right place of service and modifiers for you.

Your practice can also have optional modules turned on that change how claims behave, such as applying default fees to an encounter automatically. Ask your account team which modules make sense for you.

  Patient  ->  Encounter  ->  Claim  ->  Submitted to payer  ->  Payment posted

Add or find the patient, and record their insurance: the payer, the policy, who the subscriber is, and the order of responsibility if they have more than one plan.

The encounter is the visit. On it you record:

• The procedures performed, and which provider performed each one
• Diagnosis codes
• Providers by role, such as rendering, referring, or supervising
• SOAP notes, if you document them here

An encounter becomes a claim. As the claim is built, any rules and contract pricing you have configured are applied automatically, so contracted rates and telehealth adjustments do not have to be remembered by hand.

You can also create a claim directly without an encounter, and edit any claim before it goes out.

The claim is turned into an 837 and submitted through the clearinghouse. From there you can track it in Claim Search like any other claim, and work anything that needs attention on the Work Board.

When the payer's 835 comes back, post it against the claim from the ERA posting screen. Claim payment detail shows what was paid, what was adjusted, and why.

• AR export for aging and outstanding balances
• Patient statements for balances owed by the patient
• Denial Workbench for working denied claims
• SharpInsight for reporting across payments, denials, payers, and coding

If your practice uses Healthie, SharpRCM connects to it directly. You can bring providers, facilities, codes, and appointments across, run eligibility from your Healthie schedule, and post payments back onto claims in Healthie.

See SharpRCM with Healthie.

Need help? Contact ClaimRev support at help@claimrev.com or call 918-842-9564.