Claim build & submission
Monthly CMS-1500 / 837P claims built from your EMR, with service lines, modifiers, place of service and diagnosis pointers checked before anything leaves.
837P · CMS-1500Ohio Medicaid · Behavioral Health RCM
Clean claims.
Reconciled payments.
Revenue you can see.
Gist Billing runs the revenue cycle for community behavioral health providers, from the first 837P to the last 835 line. You get a secure workspace that shows exactly where every dollar stands.
- BAA signed before any data is shared
- MFA on every client account
- X12 837P · 835 · 270/271
BatchB-0417
Scrub statusPassed
Lines46
- Built
- Scrubbed
- Submitted
- Accepted
- Paid
Billing Ohio Medicaid managed care plans
Buckeye Health Plan, CareSource, Anthem Blue Cross, Molina Healthcare, Humana Healthy Horizons and Aetna Better Health.
6
Ohio Medicaid managed care plans billed through payer portals and clearinghouse
3X12 sets
837P claims, 835 remittance and 270/271 eligibility in one workflow
100%
of client accounts are invitation-only and protected by multi-factor sign-in
5min
session token lifetime, so access expires quickly and is re-verified
01 — Services
The full revenue cycle,
run end to end.
One team owns the work from intake to the reconciled deposit, so nothing sits between handoffs.
Behavioral health billing for Ohio practices: Medicaid managed care · OhioRISE · SUD, IOP & PHP · denials & A/R recovery
Eligibility & plan verification
Coverage checks before each cycle catch plan switches between managed care organizations, so claims go to the right payer the first time.
270 / 271Denial management
Every denial is categorized by CARC/RARC code, corrected at the root cause and resubmitted. Patterns are reported back so they stop recurring.
CARC · RARC · 277CAPayment posting & reconciliation
Remittance is matched line by line to billed services. Paid, partially paid and still-pending are always kept separate. No guesswork.
835 · ERAA/R follow-up
Aging claims are worked on a schedule, with every payer response documented. Each open balance has a named next step and a date.
A/R aging · follow-up logPractice workspace
A private portal for your team: status by patient and month, payment evidence, and the follow-up behind every open item.
Secure portal · per-practice02 — Claim lifecycle
Every claim follows
the same disciplined path.
Each stage has a check before the next one starts. When something is rejected, it goes back to the stage that caused it, not to the end of a queue.
01
Intake
Attendance, authorizations and diagnoses pulled from the EMR
02
Scrub
Codes, modifiers, units, POS and Dx pointers validated
03
Submit
837P transmitted; claim and line totals verified at review
04
Acknowledge
999 / 277CA acceptance confirmed and logged
05
Adjudicate
Denials triaged by CARC/RARC and routed back for correction
06
Reconcile
835 posted line by line; balances closed or worked
Built for community behavioral health coding
HCPCS H-codesPer-diem & 15-min unitsMod U4Mod HKMod UKPOS 53POS 99ICD-10-CM F-codesStatement-period claims
03 — Platform & security
Engineered for
protected health information.
Our client platform runs on AWS under a signed Business Associate Agreement. Patient data never appears on a public page, and each practice sees only its own records.
- Business Associate AgreementHosting runs under a Business Associate Agreement with AWS. Each client practice signs a BAA with us before any data is shared.
- Invitation-only, MFA-enforced accessNo public sign-up. Every account is provisioned by us and requires multi-factor sign-in.
- Practice isolationAuthorization is scoped per practice and covered by automated isolation tests on every release.
- Encryption and audit trailData is encrypted at rest and in transit. Sign-ins and record changes are written to an audit log.
- Short-lived sessionsAccess tokens expire in minutes and can be revoked, which limits the exposure of any lost device.
04 — Client workspace
Your billing,
on one screen.
See what's paid, what's submitted and what needs attention, for every patient and every month. Open any month for its payment evidence and follow-up history.
Explore the interactive tourThe tour uses invented sample records. No sign-up required.
Practice overviewApr — Sep · sample
Paid45
Submitted18
Needs action9
Sample Patient 01 · AprPaid
Sample Patient 04 · AugSubmitted
Sample Patient 08 · SepNeeds action
Product tour
Inside the
Gist Billing workspace.
Screens from the interactive workspace demo. The records are invented; the software is the same workspace a practice signs in to once onboarded.
05 — Engagement
A structured onboarding,
live in weeks.
- Week 0
Billing review
A call about your payers, volume, EMR and where revenue is getting stuck.
- Week 1
Agreements & access
Service scope, Business Associate Agreement and least-privilege access to your systems.
- Week 2
Data intake & audit
We map rosters, diagnoses and member IDs, and flag open A/R and recoverable denials.
- Week 3+
First billing cycle
Claims built, scrubbed and submitted, with your workspace live for your team.
- Monthly
Reporting cadence
A reconciled summary of paid, pending and denied, and what's being done about each.
Start here
Find out where your
revenue is getting stuck.
Book a no-cost billing review. We'll look at your payer mix, open A/R and denial patterns, and suggest a scope that fits your practice.
Email us
kgist@gistbilling.org
Request a billing review →
Please don't include patient information in email.
Call(567) 868-9940
Service areaBehavioral health practices
across Ohio
across Ohio