Claims

Creating claims

A claim is never typed in. It is built from charges that are already posted to the patient's account, so its total, dates, lines and payer cannot disagree with the ledger.

Written for: Billing and RCM teams · Practice administrators

Before you can build a claim

Field or control	What it means
Posted charges	Rehab charges are posted by an administrator from the Rehab Billing worklist (Rehab charge capture). Every other charge is entered on RCM Operations → Charge Capture by an Admin (it needs the submit_claims permission), and since 2026-10-12 that screen can post only a declared non-clinical charge - a supply, a fee, or work documented in another system - with a basis of at least 10 characters that is stored on the charge as its evidence. A therapy line with no delivered service behind it is refused there for every role, because it has to be charged from the visit it was recorded in, so its note, authorization and clinician's licence are checked first. The one refusal a reason can still pass is a line matching one already on the account for the same day of service, procedure code and modifier set (units are not compared); only someone who can reach that screen - in practice an Admin - may give that reason, and it is recorded in the audit trail. Only charges that are posted to the account, not voided, above zero and not already on a claim are eligible. When a claim is built, a hand-entered charge that repeats a charge from a Rehab visit, or an earlier line for the same service, is held back from the claim (not voided) unless it was entered with that recorded reason.
Coverage	Each charge must reach an insurance policy: a Rehab charge through the coverage recorded when it was created (or its episode's primary policy); a manually entered charge through the account's insurance. A self-pay episode's charges are never put on a payer claim.
Billing details for the 837P	An active facility with billing NPI and taxonomy (with several active, the one named on the claim's visits; otherwise the claim is refused as AMBIGUOUS_BILLING_FACILITY), the member id and payer id on the coverage, diagnoses on every line, and the policy holder's name when the patient is a dependent. Missing items are reported at submission.
Permission	submit_claims - held by the Administrator role only.

Build a claim

ArkCloud RCM → My Work → Accounts → (account) → Insurance Information → Submit → Build Claim

Open the patient's account and, in the Insurance Information card, the Submit tab. Its Build Claims card lists each policy. There is no manual claim entry and no New Claim button on Insurance → Claims.
Press Build Claim beside any policy. The claim is Professional (837P), or Institutional (837I) when the billing facility is set up to bill on the UB-04. The policy you pressed it beside does not limit the build.
ArkCloud takes the account's eligible charges, groups them by coverage and prior-authorization number, and builds one claim for every group in a single press.
The claim is created as Pending with a claim number, its billed amount (the sum of its lines), its service dates (earliest to latest line) and the payer from the coverage. The charges become Billed and any Rehab services on them become Claimed.
The scrub report is shown with the result. It does not stop the claim being created - see claim scrubbing.

The AR Accounts list with search and filter controls above a table of patient accounts showing balance, aging, status and assignment — AR Accounts. Open an account to reach the Insurance Information card, where Build Claim sits beside each policy.
/dashboard/ar/accounts

What goes on each line

Field or control	What it means
Procedure, modifiers, units	Copied from the charge, which copied them from the delivered service. Rehab procedure codes come from the tenant's service catalogue and are never inferred. GP, GO and GN therapy modifiers are carried as recorded.
Diagnoses	From the charge: the episode's primary diagnosis and up to three secondaries. The claim carries at most 12 diagnoses, each line points at up to 4.
Amount	The charge total: the fee-schedule rate times units for Rehab charges; the entered price for manual charges.
Rendering provider	The clinician on the visit. Sent at claim level when every line shares one clinician, per line otherwise, and omitted when it is the billing NPI.

Why a charge cannot be billed twice

The claim is Pending. Nothing has been sent. Submit it from Insurance → Claims - see claim submission.