The ClaimRev Connect module integrates ClaimRev's clearinghouse services directly into OpenEMR, giving practices access to claims processing, eligibility verification, ERA downloads, and more without leaving their EHR.

1. Download and Installation
2. Configuration
3. Features
   1. Claims Submission
   2. Claims Tab
   3. Payment Advice
   4. Reconciliation
   5. Eligibility Verification
   6. ERA Downloads
   7. X12 Tracker
   8. Appointments
   9. Notifications
4. Troubleshooting
5. Support

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• OpenEMR 8.0.0 or later
• 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.

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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 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.

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

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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• 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

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

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• 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)