OpenEMR ClaimRev Connect Module

The ClaimRev Connect module integrates ClaimRev's clearinghouse services directly into OpenEMR, giving practices access to claims processing, eligibility verification, ERA downloads, payment posting, reconciliation, patient balance management, and analytics — all without leaving their EHR.

1. Download and Installation
2. Configuration
3. Features
   1. Dashboard (Home)
   2. Claims Submission
   3. Claims Tab
   4. Payment Advice
   5. Reconciliation
   6. Patient Balance
   7. Claim Status
   8. AR Aging Report
   9. Denial Analytics
   10. Eligibility Verification
   11. ERA Downloads
   12. X12 Tracker
   13. Appointments
   14. Notifications
4. Compatibility
5. Troubleshooting
6. Support

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• OpenEMR 7.0.0 or later (8.x recommended)
• PHP 8.2 or later
• An active ClaimRev account with API credentials

Download the latest version of the ClaimRev Connect module:

Current Version: 2.0.0

Note: If you do not yet have a ClaimRev account, visit claimrev.com or contact us at sales@claimrev.com to get started.

1. Download the oe-module-claimrev-connect.zip file above.
2. Log into OpenEMR as an administrator.
3. Navigate to Modules > Manage Modules.
4. Click the Install tab, then click Upload Module and select the downloaded zip file.
5. After upload completes, find ClaimRev Connect in the module list and click Install.
6. Once installed, click Enable to activate the module.
7. Navigate to ClaimRev Connect > Setup and click Run Upgrade to create the required database tables.

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After enabling the module, you need to configure your ClaimRev API credentials.

1. Navigate to Admin > Config > Connectors.
2. Scroll to the ClaimRev Settings section.
3. Enter the following values provided by ClaimRev:
   • Client ID - Your ClaimRev API client ID
   • Client Secret - Your ClaimRev API client secret
   • API Server - The ClaimRev API endpoint URL
   • Client Authority - The OAuth token endpoint
   • Client Scope - The API scope (typically provided by ClaimRev)
4. Click Save to store your settings.

Tip: To verify your connection, navigate to the ClaimRev module and click the Connectivity tab for a connection status check. Contact ClaimRev support if you need your API credentials.

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The Home tab is a KPI dashboard that gives billers a one-glance overview of the entire revenue cycle. It refreshes every time you open the module.

• Claims In Flight — Encounters billed and awaiting payer response
• Pending ERAs — ERAs received from ClaimRev but not yet posted to OpenEMR
• Rejected / Denied — Claims denied in the last 90 days
• Clean Claim Rate — Percentage of claims accepted on first pass (90-day window). Color-coded: green (≥95%), yellow (90-94%), red (<90%)

• Total AR — Sum of all outstanding balances, with the amount over 90 days shown below
• Avg Days in AR — Average age of outstanding balances. Color-coded: green (≤35 days), yellow (36-50), red (>50)
• Collections This Month — Total payments received this month, with last month shown for comparison
• Collections This Quarter — Quarterly total

• Denial Rate — Percentage of claims denied vs. total processed (90-day window)
• Top Adjustment Reasons — The five most common adjustment reasons from posted ERAs

• Patient AR — Total outstanding patient balances (encounters where insurance has responded)
• Need Statements — Encounters with a patient balance that have never had a statement sent

Direct links to Search Claims, Payment Advice, Reconciliation, Claim Status, and Denial Analytics.

The module enables electronic claim submission (837P/837I/837D) to payers through ClaimRev.

• Claims are submitted from the OpenEMR billing manager
• Claim status and errors are viewable in the ClaimRev Claims tab
• Claims can be marked as worked after review
• CSV export of claim search results is available

The Claims tab provides a searchable view of claims submitted through ClaimRev, with integrated OpenEMR status tracking and actions.

Search for claims using any combination of:

• Patient name (first and/or last)
• Date range (service date or received date)
• Payer name or payer number
• Patient control number (PCN) — format is pid-encounter
• Claim status (e.g., Accepted, Rejected, Pending)
• Billing provider NPI

Each claim row displays the OpenEMR claim status alongside the ClaimRev status. This lets you see at a glance whether the two systems agree. OpenEMR statuses include:

Each claim row provides action buttons:

• Open Encounter (folder icon, blue) — Opens the OpenEMR encounter directly in a new tab, allowing you to review charges, notes, and clinical documentation.
• Sync Status (sync icon, red) — Appears when ClaimRev shows a claim as rejected but OpenEMR still shows it as billed. Clicking this updates the OpenEMR claim status to Denied and records the rejection reason from ClaimRev in the claim's process file. This saves manual data entry when payers reject claims.
• Requeue for Billing (redo icon, yellow) — Reopens the encounter for billing so it can be corrected and resubmitted. This resets the billing flags and creates a new claim version with status Unbilled, placing it back in the billing queue.

Click on any claim row to expand it and see:

• Full ClaimRev claim details (status, payer acceptance, ERA classification)
• OpenEMR status information
• Direct link to the encounter in OpenEMR
• Link to view the claim in the ClaimRev portal

The Payment Advice tab allows you to search for ERA (835) payment advice records from ClaimRev and post them directly into OpenEMR's payment system.

1. Navigate to the Payment Advice tab.
2. Enter search criteria (date range, payer, trace number, etc.).
3. Click Search to retrieve matching payment advice records.
4. Results show the payer name, check/trace number, payment date, total paid amount, and claim count.

Click on a payment advice record to expand it. Each claim line within the ERA shows:

• Patient name and control number
• Claim status (Paid, Denied, Reversed, Pended, etc.)
• Billed amount, allowed amount, paid amount, and adjustments
• Service line details with procedure codes and amounts

Payment advice records can be posted to OpenEMR to record payments, adjustments, and denials.

1. Expand a payment advice record to see its claim lines.
2. Click Preview on an individual claim to see exactly what will be posted.
3. The preview shows the session details, payment amounts, and adjustment codes that will be created.
4. Click Post to OpenEMR to post the payment.
5. After posting, the claim line is marked with a green checkmark.

1. Click Batch Post All to post all eligible claims in a payment advice at once.
2. The system processes each claim and shows a results summary with:
   • Posted — Successfully posted claims (green)
   • Skipped — Claims that were already posted or could not be matched (gray)
   • Errors — Claims that encountered an error during posting (red)
   • Needs Approval — Reversals and pended claims that require individual review (yellow, see below)

Some claim statuses require special attention before posting:

• Reversals (CLP02=22) — These represent a takeaway of a previous payment. Posting a reversal will create a negative payment in OpenEMR. When you click Post on a reversal, a confirmation dialog explains the impact and asks for approval before proceeding.
• Pended Claims (CLP02=5) — These indicate the payer is still processing the claim. Posting records the current adjudication info, but amounts may change. A confirmation dialog warns you of this before posting.

In batch mode, reversals and pended claims are not auto-posted. Instead, they are separated into a “Needs Approval” section in the batch results, where you can review each one individually and click Approve & Post to post them one at a time.

When an ERA is posted, the following data flows into OpenEMR:

• Payments — Insurance payments are recorded in ar_session and ar_activity
• Contractual Adjustments — CO (Contractual Obligation) group adjustments reduce the balance
• Patient Responsibility Memos — PR (Patient Responsibility) adjustments are recorded as zero-dollar memos with labels like Ins1 dedbl: 150.00, Ins1 coins: 45.00, Ins1 copay: 25.00. These memos are later parsed by the Patient Balance screen to show the PR breakdown.
• Insurance Level Close — The last_level_closed flag on the encounter is updated, indicating insurance has finished processing

A Test Mode toggle is available below the search button. When enabled:

• The search returns mock data instead of calling the ClaimRev API, allowing you to practice the posting workflow without real data.
• Posting still writes to OpenEMR (useful for testing with a development database).
• Claims are not marked as worked in ClaimRev when test mode is active.
• A yellow warning banner is displayed to remind you that test mode is active.

Important: Only use test mode in development or training environments. Do not enable test mode in production with real patient data unless you understand that mock ERA data will be posted to OpenEMR.

The Reconciliation tab provides a side-by-side comparison of OpenEMR encounters against their status in ClaimRev, helping you identify claims that may need attention.

Reconciliation answers questions like:

• “Did all my billed claims actually reach ClaimRev?”
• “Are there claims rejected in ClaimRev that I haven't updated in OpenEMR?”
• “Do I have ERAs showing payment that haven't been posted?”
• “Are there denials in the ERA that OpenEMR doesn't reflect?”

1. Navigate to the Reconciliation tab.
2. Set your search filters:
   • Date Range — Filter encounters by service date
   • OpenEMR Status — Choose from:
     • Billed — Encounters marked as billed or crossover (default)
     • Denied — Encounters marked as denied
     • All Billed — All encounters that have entered the billing process
   • Patient Name — Filter by first and/or last name
   • Payer Name — Filter by insurance company
   • Discrepancies Only — Show only encounters where the OE and ClaimRev statuses don't match
3. Click Search to run the reconciliation.

At the top of the results, four summary cards show:

• Total Encounters — Number of OpenEMR encounters matching your filters
• Found in ClaimRev — How many of those encounters were found in ClaimRev
• Not in ClaimRev — Encounters that were not found (potential submission issues)
• Discrepancies — Encounters where the OE and ClaimRev statuses disagree

The comparison table shows each encounter with columns for:

The system automatically detects five types of discrepancies:

Rows are color-coded: red for danger-level discrepancies, yellow for warnings, and gray for encounters not found in ClaimRev.

Each row provides action buttons depending on the situation:

• Open Encounter — Navigate directly to the encounter in OpenEMR
• Sync Status — Update OpenEMR to match ClaimRev's rejection status (appears for rejected claims)
• Requeue for Billing — Put the claim back in the billing queue for correction and resubmission
• View in Portal — Open the claim in the ClaimRev portal for full details

Click on any row to expand a detailed comparison showing:

• OpenEMR Info — Claim status, bill time, process file
• ClaimRev Info — Claim status, payer acceptance, worked status
• ERA Info — ERA classification, payer paid amount

The Patient Balance tab surfaces encounters with outstanding patient responsibility after insurance has responded. It helps billers identify who owes money and manage the statement workflow.

An encounter appears in the Patient Balance queue when:

• Insurance has responded (last_level_closed >= 1 on the encounter)
• There is a remaining balance after all payments and adjustments (using the same formula as OpenEMR's collections report: charges + drug sales - payments - adjustments)

• Service Date Range — Filter by encounter date
• Patient Name — Search by patient first or last name
• Payer — Filter by primary insurance company
• Min Amount — Only show balances above a threshold (default: $0.01)
• Statement Status — Filter by:
  • All — Show everything
  • Never Sent — Encounters where no statement has been sent
  • Sent 1x — Exactly one statement sent
  • Sent 2+ — Two or more statements sent
  • In Collection — Encounters marked as in collection

• Total w/ Balance — Number of encounters with outstanding patient balances
• Total Amount — Sum of all outstanding patient balances
• Never Sent — Encounters needing their first statement
• Sent 1x / Sent 2+ — Statement frequency breakdown
• In Collection — Encounters flagged for collections

Click any row to expand and see:

• Patient Responsibility Breakdown — Parsed from the ERA posting memos. Shows the breakdown of why the patient owes money:
  • Deductible — Amount applied to the patient's deductible
  • Coinsurance — Patient's coinsurance portion
  • Copay — Copay amount
  • Pt Resp — Other patient responsibility amounts
• Per-Code Breakdown — Each procedure code with its charge, adjustment, and remaining balance (from OpenEMR's InvoiceSummary)
• Statement History — Log of all statements sent for this encounter, with date, method, amount, and who sent it

• Generate Statement (file icon) — Opens OpenEMR's built-in statement tool (sl_eob_search) where you can print or email patient statements
• Mark Sent (check icon) — Records that a statement was sent for this encounter. Logs the date, amount, and user to the statement history.
• Add Note (sticky note icon) — Add a free-text note to the encounter's statement history
• View Ledger (book icon) — Opens the OpenEMR payment ledger for the encounter
• Open Encounter (folder icon) — Opens the encounter in OpenEMR
• Generate via ClaimRev (cloud icon, disabled) — Placeholder for future ClaimRev statement generation integration

The module tracks statements in its own mod_claimrev_patient_statements table. The queue shows whichever count is higher: the module's own count or OpenEMR's native stmt_count on the encounter. This means statements sent through either system are reflected.

The Claim Status tab provides a work-queue style dashboard for tracking claims through their lifecycle, with real-time 276/277 status checks.

• Work Queue — Claims sorted by status, showing which need attention
• Timeline View — Click any claim to see its full event history: submitted, accepted, rejected, ERA received, payment posted, manual notes
• Real-Time Status Check — Send a 276 status inquiry to the payer and get a 277 response showing current claim status
• Batch Sync — Sync multiple claims from ClaimRev at once to update local tracking data
• Manual Notes — Add notes to any claim's timeline for team communication
• Dashboard Stats — Summary cards showing claims by status category

Claims are categorized into actionable groups:

• Needs Attention — Rejected, denied, stale (no update in 30+ days), or paid but not posted
• In Progress — Submitted, accepted by payer, awaiting adjudication
• Completed — Paid and posted, or worked and resolved

The AR Aging Report is found under the Analytics dropdown in the navigation bar. It provides a standard 30/60/90/120 day aging breakdown of accounts receivable, grouped by payer.

1. Click Analytics > AR Aging Report in the navigation bar.
2. Optionally filter by payer name, patient name, or minimum balance amount.
3. Click Run Report.

• Total AR — Sum of all outstanding balances
• Aging Buckets — Dollar amounts in each bucket: 0-30, 31-60, 61-90, 91-120, 120+ days
• Payer Count — Number of distinct payers with outstanding balances
• Encounter Count — Total encounters with balances

Each row represents a payer and shows:

Payers are sorted by total AR descending — the biggest balances appear first.

Click Export CSV to download the full encounter-level aging data as a spreadsheet. The CSV includes patient name, encounter, service date, payer, age in days, aging bucket, balance, insurance level, and statement count.

The Denial Analytics page is found under the Analytics dropdown. It analyzes adjustment and denial patterns to help identify systemic issues with specific payers or procedure codes.

1. Click Analytics > Denial Analytics in the navigation bar.
2. The report auto-runs on page load showing the last 12 months of data.
3. Optionally filter by date range or payer name.
4. Click Analyze to refresh.

• Total Adjustments — Number of individual adjustment line items in the period
• Total Adjusted — Dollar amount of all adjustments
• Encounters — Number of distinct encounters affected
• Payers — Number of distinct payers

The left panel shows the 20 most common adjustment reasons, with:

• Reason — The adjustment memo as recorded during ERA posting (e.g., “Adjust code 45”)
• CARC Code — The Claim Adjustment Reason Code number, if present
• CARC Description — Human-readable description (e.g., “Charge exceeds fee schedule/max allowable”). The module includes descriptions for 30+ common CARC codes.
• Count — How many times this adjustment appeared
• Amount — Total dollar amount adjusted
• Visual bar — Relative frequency compared to the top reason

The right panel shows adjustments grouped by payer:

• Which payers have the most adjustments
• Total adjusted amount per payer
• Number of encounters affected per payer

This helps identify payers that are consistently adjusting or denying claims.

Below the payer breakdown, a monthly trend table shows adjustment counts and amounts over time, with visual bars. This helps answer: “Are our denials getting better or worse?”

Click Export CSV to download the denial reason data as a spreadsheet for further analysis.

Real-time eligibility verification is available from the patient demographics page.

• Eligibility - Standard 270/271 eligibility check with benefit details
• Coverage Discovery - Find active coverage for a patient
• Demographics - Verify patient demographic information with the payer
• MBI Finder - Look up a patient's Medicare Beneficiary Identifier

1. Open a patient's chart and navigate to the Demographics screen.
2. In the ClaimRev section, select the payer responsibility tab (Primary, Secondary, etc.).
3. Select one or more products to check using the checkboxes.
4. Click Check Now for immediate results, or Queue Check to process in the background.
5. Results appear in tabbed sections: Quick Info, Deductibles, Benefits, Medicare, and Validations.

The Conversation tab provides an AI-powered assistant that can answer questions about the eligibility response. Ask questions like:

• “What is the patient's deductible?”
• “Is this patient covered for outpatient services?”
• “Summarize the key benefits”
• “What are the co-pay amounts?”

Eligibility results can be synced to OpenEMR's native Insurance card Eligibility tab by clicking the Sync to Insurance Card button. This populates the standard eligibility verification and benefit tables so the data is visible on the patient dashboard.

Electronic Remittance Advice (ERA/835) files from payers can be downloaded and imported into OpenEMR.

• Search for available ERA files by date range
• Download individual files for import into the OpenEMR billing system

The X12 Tracker tab shows the history of X12 files (837, 835, 270/271, 276/277, etc.) that have been transmitted through ClaimRev.

• View submitted and received X12 files with timestamps
• Track file acceptance and rejection status
• Download original X12 files for review or troubleshooting

The Appointments tab provides visibility into appointment-related data synced with ClaimRev, supporting eligibility verification workflows tied to scheduled visits.

Portal notifications from ClaimRev are accessible within the module, keeping you informed of important updates about your claims and account.

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The ClaimRev Connect module supports:

• OpenEMR 8.x — Full native support
• OpenEMR 7.x — Supported via built-in compatibility shims

The module includes automatic compatibility shims for classes introduced in OpenEMR 8.x (OEGlobalsBag and ServiceContainer). On OpenEMR 7.x, these shims provide equivalent functionality by wrapping $GLOBALS and CryptoGen directly. On 8.x, the shims are never loaded — the native classes are used.

To verify the module works correctly on your OpenEMR version:

1. Navigate to ClaimRev Connect > Connectivity.
2. Click the Run Compatibility Check button.
3. A diagnostic page shows the status of each critical component:
   • OEGlobalsBag — Whether the native class or shim is in use
   • ServiceContainer — Whether the native class or shim is in use
   • GlobalConfig and Bootstrap — Whether they instantiate successfully
   • OpenEMR version and PHP version

If all checks show green, the module is fully operational. If any check shows “Using ClaimRev shim (7.x mode)”, the module is running with compatibility shims — all features work normally.

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• Verify your API credentials in Admin > Config > Connectors
• Ensure your server can reach the ClaimRev API endpoint (check firewall rules)
• Check the OpenEMR error log for detailed error messages
• Use the Connectivity tab in the module to test your connection

• Verify the patient has insurance data entered with a valid payer
• Ensure the payer is enrolled for eligibility transactions — see Payer Enrollments
• Check that the subscriber ID and patient demographics are accurate

• Confirm the claim was submitted through the OpenEMR billing manager
• Check the X12 Tracker tab to verify the 837 file was transmitted
• Use the Reconciliation tab to identify claims that were billed in OpenEMR but not found in ClaimRev

• Ensure the encounter exists in OpenEMR and the patient control number matches (format: pid-encounter)
• Check that the encounter has not already been fully paid
• Review the error message in the posting results for specific details
• If using test mode, remember that mock data may not match real encounters

• Make sure ERAs have been posted — the Patient Balance queue only shows encounters where last_level_closed >= 1 (insurance has responded)
• Navigate to Setup and click Run Upgrade to ensure the mod_claimrev_patient_statements table exists
• Try lowering the Min Amount filter or clearing all filters

• If you see SQL errors when clicking Run Upgrade on the Setup tab, check the OpenEMR error log for the specific query that failed
• The upgrade process is idempotent — it skips tables and rows that already exist, so it is safe to run multiple times

• Confirm the module is both installed and enabled in Modules > Manage Modules
• Clear your browser cache and reload the page

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• KPI Dashboard — Home tab replaced with a full revenue cycle dashboard showing claim pipeline, AR metrics, collections, denial rates, and patient responsibility at a glance
• Patient Balance Queue — New tab showing encounters with outstanding patient responsibility after insurance has responded. Includes PR breakdown (deductible/coinsurance/copay parsed from ERA memos), per-code detail, statement tracking, and actions to generate statements or mark as sent
• Claim Status Dashboard — New work-queue tab with claim lifecycle timeline, real-time 276/277 status checks, batch sync, and manual notes
• AR Aging Report — New analytics page with 30/60/90/120 day aging buckets grouped by payer, distribution visualization, and CSV export
• Denial Analytics — New analytics page analyzing adjustment patterns by reason code, payer, and monthly trend with CARC code descriptions and CSV export
• Analytics Dropdown — AR Aging Report and Denial Analytics grouped under an “Analytics” dropdown in the navigation bar
• OpenEMR 7.x Compatibility — Built-in compatibility shims allow the module to run on OpenEMR 7.x without modification. A compatibility check tool is available under Connectivity.
• Compatibility Check — New diagnostic page (Connectivity > Run Compatibility Check) verifies all module dependencies resolve correctly
• Statement Tracking Table — New mod_claimrev_patient_statements database table for tracking statement history per encounter

• Claims Tab — Added OpenEMR claim status display, encounter links, status sync (ClaimRev rejected → OE denied), and requeue-for-billing action
• Payment Advice — New tab for searching, previewing, and posting ERA/835 payment advice to OpenEMR (single and batch), with approval workflows for reversals and pended claims
• Payment Advice Test Mode — Mock data mode for testing the posting workflow without live API calls
• Reconciliation — New tab that compares OpenEMR encounters against ClaimRev statuses with automatic discrepancy detection
• X12 Tracker — File transmission history and download

• Initial release
• Claims submission (837P/I/D)
• Real-time eligibility verification (Eligibility, Coverage Discovery, Demographics, MBI Finder)
• AI-powered eligibility assistant
• ERA file downloads
• Portal notifications
• Native OpenEMR eligibility sync

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If you need help with the ClaimRev Connect module:

• Email: support@claimrev.com
• Phone: 918-942-9564
• Hours: Monday - Friday, 9 AM to 5 PM (CST)