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What InvisaClaim is

InvisaClaim is a revenue-cycle and denial-management platform. It brings your claims into one place, checks them before they go out, tracks them until they're paid, and helps you fight back — with real evidence — when a payer says no.

Most billing tools stop at submission. InvisaClaim is built around the part where the money actually gets lost: the back-and-forth after a claim is filed. It watches for denials, sorts them by why they happened, drafts appeals backed by the patient's own records, and manages the harder escalation paths — peer-to-peer reviews, prior-authorization disputes, and No Surprises Act arbitration — that most teams don't have time to pursue.

You can use InvisaClaim as your day-to-day claims workspace, or bolt it onto an existing billing setup purely to recover denials. This guide is organized the way a claim actually moves — from the moment it enters the system to the moment it's paid — so you can find any feature by asking, "where is my claim right now?"

Setup Guide & onboarding

The built-in Setup Guide walks you through getting your account ready. Rather than a static checklist, it watches your live account and checks items off automatically as you complete them — connect a clearinghouse and that step marks itself done.

It's organized into guided flows so you can follow the path that matches how you plan to use the platform, and your progress is saved, so you can leave and pick up exactly where you left off.

1. Connect your data. Link a clearinghouse and/or EHR so claims and remits flow in on their own.
2. Confirm your providers. Add the NPIs you bill under so claims match to the right provider.
3. Choose your plan. Start your trial and pick the plan that fits the work you're doing.

Plans, trial & billing

InvisaClaim is priced per provider (per NPI) per month, so you only pay for the providers you actually bill under. Every account starts with a 30-day free trial (a card is required to begin), and you can move between plans as your needs change.

Prepaid terms & discounts

If you'd rather not pay monthly, you can prepay in 3-, 6-, or 12-month terms for a discount. The longer the term, the larger the saving.

Managing your subscription

Billing is handled securely through the app. You can update your card, change plans, switch to a prepaid term, and review invoices from your billing settings. The platform sends billing and renewal notices by email so nothing lapses by surprise — see Email notifications.

Roles & permissions

InvisaClaim uses role-based permissions so each team member only sees and does what their job requires. A front-desk user registering patients doesn't need the same access as a billing manager submitting claims or an administrator managing the subscription.

Assign roles when you invite teammates. Permissions govern who can view patient records, submit and correct claims, work denials, manage billing, and change account settings. Every meaningful action is recorded in the audit log (see Security & compliance).

Ways to add claims

There are four ways to get claims and remittances into InvisaClaim. Most teams use a mix: automated feeds for the bulk of the work, and manual entry for one-offs.

1. Upload an ERA / 835 file

Drop in a standard 835 electronic remittance advice (ERA) file and InvisaClaim reads it automatically — pulling in the claims, the payments and adjustments, and the reason codes behind any denials. This is often the fastest way to load a backlog of remits and immediately see what was denied and why.

2. Import a CSV of claims

Have a spreadsheet of claims? Use CSV intake. You'll get a preview of how your columns map before anything is created, so you can confirm the data looks right, then create the whole batch of cases in one step.

3. Enter a claim manually

For a single claim, the manual claim entry form lets you type it in directly — useful for a one-off, a corrected claim, or a case that came in outside your usual feeds.

4. Automated feeds

Connect a clearinghouse or EHR and claims and remits flow in on a schedule without anyone lifting a finger. These are covered next.

Clearinghouse sync

Connect your clearinghouse and InvisaClaim keeps itself up to date automatically, pulling in new remittances roughly every 15 minutes. Denials show up in your worklist shortly after they land, instead of waiting for someone to download a file.

Through the clearinghouse connection, InvisaClaim also supports the core electronic transactions you rely on: real-time eligibility, claim status, batch claim submission, and electronic remittance (ERA). Those are described in their own sections below.

EHR connections

InvisaClaim can connect directly to your electronic health record so patient and encounter data flows in without re-keying. You set up a connection yourself from the EHR connections area — once linked, syncs run on a schedule to keep charts and claims current.

These connections use modern healthcare-interoperability standards (FHIR), so the data comes across structured and ready to work with — patient demographics, encounters, and the clinical detail that later powers evidence-based appeals.

NPI & provider matching

Every claim needs to attach to the right billing provider. InvisaClaim matches claims to providers by NPI automatically as data comes in, so remits and claims sort themselves to the correct provider without manual assignment.

Provider details — including taxonomy (specialty) — are pulled from the national NPPES registry, so your provider records stay accurate and consistent with what payers see. On the rare occasion a claim arrives with an NPI that doesn't match a provider in your account, it's held aside so you can resolve it rather than silently dropped.

Patient profiles & files

Each patient has a profile that gathers everything about them in one place — their claims, prior authorizations, documents, and history. Because claims link to patients automatically at intake, the profile fills itself in as data flows through the system.

Files tab

Every patient has a Files tab for storing documents — clinical notes, correspondence, images, anything relevant to their claims. Just drag and drop to upload. Files are stored securely and opened through temporary, signed links, so documents aren't left exposed on a public address.

E-prescribing view

Where prescribing data is available through Photon Health, the patient profile can display e-prescribing information, giving you medication context alongside the rest of the record.

Patient self-registration

InvisaClaim includes a kiosk mode that lets patients register themselves — on a tablet at your front desk, for example. It's designed to be safe to hand to a patient:

• The kiosk is locked to the registration screen and only exits with a staff PIN, so patients can't wander into the rest of the app.
• Submissions land in a staging area rather than going straight into your records.
• A staff member reviews and approves each registration before it becomes an active patient — so a typo or duplicate never slips through unchecked.

Eligibility checks

The cheapest denial to fix is the one that never happens. InvisaClaim checks coverage before a claim goes out, so you catch inactive plans and coverage problems while you can still do something about them.

Real-time eligibility

Check a patient's coverage on demand and in real time against the payer, confirming the plan is active and the patient is covered before you submit.

Prior-authorization eligibility

For prior authorizations, InvisaClaim runs a bulk preflight — check a whole batch at once — and shows the result as a per-row badge so you can scan a list and immediately see which patients are good to go and which need attention. Behind the scenes, the platform automatically routes each check to the correct payer, so you don't have to look up trading-partner details yourself.

Pre-Submission Check

Before a claim leaves InvisaClaim, the Pre-Submission Check reviews it for the problems that commonly trigger denials — and flags them while they're still easy to fix. Think of it as a smart scrubber that reads each claim and tells you what a payer is likely to reject and why.

The check gets smarter over time: when remittances come back, InvisaClaim feeds what actually got denied back into the pre-check, so the system keeps learning which issues to watch for with your specific payers and claim mix.

NCCI & line-item edits

InvisaClaim checks your claim lines against NCCI (National Correct Coding Initiative) edits — the federal rules about which procedure codes can and can't be billed together. Catching an NCCI conflict before submission avoids a predictable denial.

Each claim breaks out into individual line items so you can see and work with the claim at the code level — exactly where coding problems live. And when a claim does get denied over coding, the relevant edit detail can be carried straight into your appeal letter to support the case for payment.

Submitting claims

Once a claim is clean, submit it electronically through your connected clearinghouse. InvisaClaim supports batch submission, so you can send many claims at once rather than one at a time.

Claim status

After a claim is out the door, InvisaClaim tracks its status electronically with the payer — so you can see where each claim stands without logging into payer portals or making phone calls. Combined with the automatic ERA sync, you get a continuously updated picture of what's paid, pending, and denied.

Corrected-claim resubmit

When a claim needs to be fixed and refiled, InvisaClaim has a dedicated corrected-claim resubmit path. It keeps a full audit trail of the original claim alongside the correction, so you always have a record of exactly what changed.

Because refiling a corrected claim requires the original claim's control number, the resubmit path gates on that identifier and asks you to confirm before sending — a deliberate safeguard against filing a correction incorrectly. Corrected-claim actions are available throughout the platform wherever you're working a claim.

ERA / payment posting

When payers respond, they send an electronic remittance advice (ERA / 835) explaining what they paid, what they adjusted, and what they denied. InvisaClaim reads these automatically — whether they arrive by clearinghouse sync or by direct upload — and turns them into clear, worked-through records.

A key part of this is how InvisaClaim classifies adjustments. Not every reduction is a denial — some are contractual write-offs, patient responsibility, or routine adjustments. The platform sorts these correctly so your team spends its energy on the denials that are actually worth appealing, not the ones that were never going to pay differently.

As noted earlier, every remit also feeds back into the Pre-Submission Check, closing the loop between what you sent and what came back.

Collecting payments

InvisaClaim connects to payment processors so you can collect money owed. It supports Stripe (via Stripe Connect) and Square, which you authorize through a secure connection flow — no card credentials are ever handled by InvisaClaim directly.

Worklist & Case Queue

The Worklist is your command center. It's built as an enterprise cockpit — the home base your team works out of every day — pulling the claims and denials that need attention into one prioritized view.

From the Case Queue, work is routed to the right place based on what kind of case it is, so denials don't sit in an undifferentiated pile. Everyone can see what needs doing, in priority order, and pick up the next case without hunting for it.

Denial Workbench

The Denial Workbench is where you actually work a denial. It brings together everything about the denied claim — the reason it was denied, the underlying claim and line items, the patient's records, and the tools to respond — so you can resolve it without jumping between screens.

Denials are routed by category: the platform recognizes why a claim was denied and steers it down the right workflow. A coding denial, an authorization denial, and a medical-necessity denial each call for a different response, and InvisaClaim points you at the appropriate path for each rather than treating every denial the same.

Denial pattern intelligence

Beyond working denials one at a time, InvisaClaim looks across your denials to surface patterns — the recurring reasons, payers, or codes that keep costing you. This turns your denial history into something actionable: if a particular payer keeps rejecting a particular code, you'll see it, and you can fix the upstream cause instead of endlessly appealing the same denial.

Appeal generation

This is where InvisaClaim earns its keep. Instead of writing every appeal from scratch, the platform reads the patient's records, pulls out the evidence that supports payment, and drafts an appeal built around it.

The evidence extraction engine mines the clinical documentation for the facts that matter to the specific denial — the notes, findings, and history that make the case for why the claim should be paid. Those facts are then assembled into a generated appeal letter that argues the case with the evidence attached, rather than a generic template you have to fill in by hand.

Where relevant, supporting coding detail (such as the NCCI edit behind a coding denial) is woven into the letter automatically, so the appeal speaks directly to the reason the claim was denied.

Confidence & evidence-strength scoring

Not every denial is worth the same effort. InvisaClaim scores each case on the strength of the available evidence and the confidence that an appeal will succeed. That score helps your team prioritize — put your energy behind the appeals most likely to win, and make an informed call on the ones where the evidence is thin.

AOR forms

Many appeals and disputes require an Appointment of Representative (AOR) form. InvisaClaim generates these as fillable PDFs, laying your data onto the correct form fields automatically so you're not hand-filling paperwork. The field mappings are maintained centrally, so the forms stay accurate as requirements change.

Prior-authorization documents

InvisaClaim gives you two views of your prior-auth paperwork:

• A per-PA panel attached to each individual prior authorization, so the documents for a specific auth live right alongside it.
• A cross-PA Library that collects prior-auth documents across all of them in one place, so you can find a document even when you're not sure which auth it belongs to.

Peer-to-peer (P2P)

When a denial calls for a peer-to-peer review — a clinical conversation between your provider and the payer's medical reviewer — InvisaClaim manages the workflow: setting it up, tracking it through its stages, and keeping the associated records together.

P2P reviews are deadline-driven, and missing the window can forfeit the appeal. InvisaClaim surfaces P2P deadlines with a dedicated filter so you can see at a glance which reviews are time-sensitive, and those deadlines also flow into your calendar (see Dashboard & calendar).

No Surprises Act / IDR

For out-of-network payment disputes that fall under the federal No Surprises Act (NSA), InvisaClaim supports the Independent Dispute Resolution (IDR) process — the arbitration path for settling what an out-of-network claim should pay.

How the workflow works

InvisaClaim helps you build the dispute packet — assembling your offer and the supporting information that backs it up — so it's ready to submit through the Federal IDR portal. Because that portal requires credentialed sign-in and doesn't allow fully automated filing, the final submission is done by an authorized member of your staff, working from the packet InvisaClaim has prepared.

Making your case

IDR is decided on the numbers and the evidence — the arbitrator weighs each side's offer against the credible information supporting it. InvisaClaim helps you put together a credible rebuttal to the payer's qualifying payment amount (QPA), which is especially important in disputes with payers who lead with QPA-based offers. If you're pushing for a rate above the benchmark, the platform helps you marshal the supporting evidence needed to justify it.

Liens

For cases that involve a lien — common in personal-injury and third-party situations — InvisaClaim manages the full lien workflow from start to finish, and keeps documents attached to each individual lien so the paperwork for a given case stays together and easy to find.

Dashboard & calendar

The Worklist home doubles as your dashboard — the single view your team starts from. Alongside it, a calendar aggregates the time-sensitive events across your work — including P2P deadlines and other dated items — into one place, so nothing with a due date slips past unnoticed.

CMS news feed

InvisaClaim includes a built-in CMS news feed, surfacing relevant updates from the Centers for Medicare & Medicaid Services right inside the app — so the regulatory changes that affect your billing show up where you're already working, not in a separate newsletter you'll forget to read.

Email notifications

InvisaClaim keeps you informed by email so you don't have to live inside the app to stay current. A full billing email suite covers your subscription — trial reminders, receipts, renewals, and payment notices — and billing-related notifications are sent across the platform's payment paths so account events reach you reliably.

Security & compliance

InvisaClaim handles protected health information, and it's built accordingly.

• HIPAA audit log. The platform keeps a HIPAA-oriented audit log recording who did what and when — the accountability trail you need for compliance and for answering "who touched this record?"
• Role-based permissions. Access is scoped to each person's role, so staff only reach the data and actions their job requires (see Roles & permissions).
• Secure document handling. Patient files are stored securely and served through temporary, signed links rather than open URLs.
• Business Associate Agreement. InvisaClaim operates under a BAA, the standard agreement that governs how a vendor may handle PHI on your behalf.

Glossary

A quick reference to the acronyms used throughout InvisaClaim and this guide.

835 / ERA

Electronic Remittance Advice — the standard electronic file a payer sends explaining what it paid, adjusted, and denied.

AOR

Appointment of Representative — the form authorizing someone to act on a patient's behalf in an appeal or dispute.

CSV

A simple spreadsheet file format used here for importing claims in bulk.

EHR

Electronic Health Record — the clinical system where patient charts and encounters live (Epic, Cerner, athenahealth, etc.).

IDR

Independent Dispute Resolution — the federal arbitration process for out-of-network payment disputes under the No Surprises Act.

NCCI

National Correct Coding Initiative — federal rules on which procedure codes may be billed together.

NPI

National Provider Identifier — the unique number identifying a billing provider.

NPPES

The national registry of provider identifiers and their details (including specialty/taxonomy).

NSA

No Surprises Act — the federal law governing out-of-network and surprise-billing situations.

P2P

Peer-to-Peer review — a clinical discussion between your provider and the payer's reviewer to overturn a denial.

PA

Prior Authorization — payer approval obtained before a service is rendered.

QPA

Qualifying Payment Amount — the payer's benchmark rate, central to No Surprises Act disputes.

RCM

Revenue Cycle Management — the end-to-end process of getting a claim from service to payment.