Billing operations

How billing works end-to-end

Before working the individual tabs, it helps to see the whole pipeline. Hero EMR is built so that money follows the chart on its own: every hand-off below happens automatically, and the system only asks for a person when it hits something it can’t fix itself.

1. A visit is signed. Billing starts the moment the clinician signs and closes the encounter (see Sign & close) — there is no separate “send to billing” step.
2. Charges are priced. The visit’s E/M and CPT codes become charges. Cash visits are priced by your layered billing setup — organization defaults, service overrides, and per-patient exceptions. Insurance charges bill the payer’s contract rate, else a price you set in CPT List Prices, else a rate learned from that payer’s payments, else the list’s default price (CPT prices & payer rates). A code with no price at all holds the visit’s claim until you price it — Hero never files a $0 line.
3. A claim is built and checked. For insured visits Hero EMR assembles the claim and runs readiness checks, so coding, demographic, and policy problems surface as fix before send issues in your queue instead of as payer rejections weeks later.
4. Claims go to the clearinghouse. Ready claims leave by your practice’s claims route: Stedi sends them automatically every few minutes; Office Ally SFTP (and Availity SFTP) take them in a daily batch at a set time in your practice’s time zone; Optum-only practices send through Optum; or a biller submits them by hand or downloads a claim file (Manual 837P download) to upload elsewhere. The Claims Pipeline’s route line says which applies to you (see the claims pipeline). The clearinghouse answers with acknowledgements — a per-claim 277CA verdict, plus a file-level receipt (TA1 / 999) from clearinghouses that send one — confirming each claim actually arrived and was accepted for processing. Some connections never return a file-level receipt; Hero then relies on the 277CA and shows the missing receipt as Not returned rather than pending forever. A claim the clearinghouse bounces at this step shows as Rejected: it never reached the payer, so there is no decision to appeal — you fix the data and refile it (see the claims pipeline).
5. The payer adjudicates — and the money posts itself. The payer decides what it pays, what it writes off, and what the patient owes, then sends back an electronic remittance (an 835 / ERA file). Hero EMR ingests it automatically and posts the payments and contractual write-offs to each claim — an 835 you upload yourself posts the same way. Anything a person has to decide waits in Unposted Remittances with the reason and the next step.
6. What’s left becomes patient responsibility. Only after adjudication does the remainder — copay, coinsurance, deductible — move onto the patient’s balance, where statements and collections take over. Patients are never billed amounts insurance is still deciding.

Open and navigate the Billing Command Center

Day-to-day money work happens in the Billing Command Center — one workspace for pre-visit readiness, claims, payment posting, patient balances, and recurring-revenue programs. The header shows your organization name and the active payment-model label (Insurance, Pure Cash, DPC, Hybrid Insurance + Cash, or Not Set), and the whole workspace adapts to that model and to each user’s permissions — so two staff members can legitimately see different tabs.

1. Open the workspace. Administrators and physician practice owners can open Billing from the Admin toolbar menu; anyone who can use Billing gets a Billing link and a Billing inbox count on the Home page, and Alt + 6 jumps to it from anywhere. Staff whose permissions include billing work start in Billing when they sign in. Other parts of Hero EMR deep-link in too: the calendar’s appointment window can jump straight to a visit’s billing records, opening the Claims Pipeline focused on that encounter (see the calendar).
2. Pick up where you left off. Billing opens on the Dashboard — or, for logins without Dashboard access (Front Desk, for example), on Patient AR → Day Sheet. Leave Billing for another workspace tab and come back (the tab, Alt + 6, or the Home link) and it reopens the page you were on, with its filters, for as long as that browser tab stays signed in. The very first time, the sidebar shows grey placeholders and the page reads Loading billing workspace… until your tools are known, so nothing jumps under the pointer.
3. Learn the sidebar groups.
   • Operations — Dashboard (the Billing Monitor, the pipeline-health view covered in Monitor billing health), Pre-visit (the upcoming-visit readiness worklist — see Visit readiness), Claims Pipeline, Appeals (while the appeal kit is on, for people who manage claims), Prior Auths, Payments, Patient AR. The billing reports moved to Practice Health → Reports (old links to Billing → Reports open it), with the same numbers, date-range and group-by controls, and one-click CSV / Excel / PDF export; a report runs as soon as it opens. Date ranges are calendar periods in your practice’s time zone, with the resolved dates shown under the select and on the result. The AR Aging Report places each account in one bucket (0–30 … over 120 days) by its oldest open balance and splits it into Patient AR, Pending with insurance, and Insurance AR, adding up to the same Total receivable as the Billing Monitor. The Revenue & Collections Summary shows charges, payments net of refunds, and the collection rate, with membership dues listed separately (for users who may see membership money). Reports grouped by payer show one row per payer, with its Payer IDs. The payer denial-rate report counts only claims the payer actually adjudicated and denied; claims the clearinghouse bounced before the payer saw them are broken out in their own Rejected Before Payer column, so routine transmission fixes never inflate your denial rate. Payers Hero knows to be clearinghouse test payers (the sandbox payers a demo or test practice uses) are left out of the payer reports — Denial Rates by Payer (rows, totals and exports), CPT Payment Analysis, and the by-payer view and spike alerts of Denial Trends & Spike Alerts — with the line “Clearinghouse test payers are not included: {names}.”; a practice without one sees no change. IDR — a narrow out-of-network dispute workflow under the No Surprises Act — appears here only if your practice enables it under Additional Features. The group ends with Billing Hero, the AI billing assistant, and Billing Queue (formerly Human Review), which opens the Billing Queue page, the queue of billing problems that need a person; it also has its own tab in the top menu.
   • Programs — APCM, covered in APCM billing; RPM, when remote patient monitoring is on; Maternity, the global maternity-package worklist where proposed obstetric episodes are reviewed (Pending review, Pending facts, Confirmed, Dismissed), their facts and linked visits checked, and the global package confirmed into a claim; and Subscriptions, the membership workflow documented in Memberships. APCM, RPM, and Maternity appear only when enabled — Maternity needs obstetrics turned on under Additional Features, and confirming an episode additionally requires the claims-management permission.
   • Configuration — Payment Model, Collections & Fees, Card readers, Service Menu, Discounts & Coupons, Sales Tax, CPT List Prices, Denial Self-Pay, Negotiated Rates, Claim Submission, Eligibility, Billing Identity, Rules & Overrides, and Simulator. This is the setup material covered in Billing setup. If you switch tabs with unsaved Collections & Fees edits, an Unsaved changes dialog asks before discarding (Keep editing / Discard). Dialogs that hold unsaved edits work the same way: their Cancel or Close button, ×, Esc, or a click outside asks “Discard unsaved changes?” before throwing the edits away.
4. Open a patient’s billing from any name. Every patient name in Billing — Claims Pipeline rows and claim headers, Pre-visit, Patient AR (Aging, Invoices, Day Sheet), Subscriptions, Payments, APCM, IDR, and Maternity — opens the Patient billing dialog over the tab you are on, which keeps its filters (hover: Open patient billing). The dialog shows the patient’s name, MRN, DOB, age, and sex, an Open chart button for users who can open charts, and the tabs your permissions allow, in this order: Demographics · Prior Auth · Custom Billing Rules · Insurance · Invoices & Charges. With the standard role profiles, a Biller gets Demographics, Prior Auth, Insurance, and Invoices & Charges; a Billing Manager, Office Manager, or admin gets all five; Front Desk gets Demographics, Insurance, and Invoices & Charges. Billers fix a patient’s address and guarantor and their insurance here. The Biller role profile (and so Billing Manager and Office Manager) also includes read-only charts and visit notes, Media documents, appointment scheduling, and moving a claim to another payer in Correct & Refile. A practice that takes chart access away from a biller keeps them to the billing screens, and Open chart is hidden for them.
5. Understand why tabs differ per person. Tab visibility follows the payment model first — Pure Cash practices don’t see Claims Pipeline, Negotiated Rates, or Rules & Overrides by default, and DPC practices also don’t see CPT List Prices — and is then filtered by each staff member’s billing permissions (assigned with role profiles). The rule is the same for staff and admins. A staff member with no matching permission sees No billing tools are available for this staff profile. When the model hides a tool you are allowed to use, the sidebar footer shows Show all tools (and, once on, Use model defaults); a Dashboard chip or link that points at such a hidden tool shows all tools for the rest of that visit and opens the tool.

For Take payment, reader setup, and front-desk refunds, see Payments & card readers. Optional code-pair checks, tertiary claims, and denial self-pay prices are covered in Insurance follow-up.

Monitor billing health (the Billing Monitor)

The Dashboard tab is the Billing Monitor — one live picture of the organization’s billing pipeline over a window you pick (7d / 30d / 90d, plus Refresh). Instead of hopping between tabs to ask is billing healthy?, you read one strip left to right and click whatever looks wrong.

1. Read the lifecycle strip. Eight linked stages mirror the end-to-end pipeline: Signed → Charges → Claims → Submitted → Acknowledged → Adjudicated → Posted → Patient balance, each with its count or dollars for the window. A dashed amber No billing / Cash tile sits directly after Signed, counting signed visits that never enter the insurance pipeline (no claim) — it is informational, not an exception chip, so there is nothing to click and nothing to work. Every stage is clickable and jumps to the tab that works it — the claim stages open the Claims Pipeline, the money stages open Payments or Patient AR.
2. Work the exception chips. Chips appear under a stage only when something there needs attention, colored by severity and stamped with the age of the oldest problem (oldest Nd). A clean strip means a clean pipeline — there is nothing to dismiss. Each chip deep-links to the tab where you fix it; the table below shows what can surface where.
3. Scan the Billing Inbox rollup. The Billing Inbox panel summarizes the alert rail without leaving the workspace: an N active badge, one chip per alert type and severity (for example Charge AR drift 17 or ERA manual review 2), and the newest alerts with timestamps. Open billing inbox jumps to the main Inbox’s Billing folder (see Inbox queues for how that folder groups and dates alerts), and the same active count shows as a red badge on the Dashboard tab in the sidebar — visible from anywhere in the workspace.
4. Read the money row. A line above the cards adds up what the practice is owed: Total receivable = Patient AR + Pending with insurance + Insurance AR · Same total as Reports → AR Aging. Then three cards: Insurance AR — “Not filed yet, or back from the payer and needing billing review — excludes claims waiting on the payer”, split into Not filed yet and Needs billing review and aged 0–30 days through Over 120 days; Patient AR with its aging buckets and a Pending with insurance line (“Filed claims waiting on the payer; excluded from Patient AR”); and Collected in window split into insurance and patient collections, with a footer showing ERA ingestion health — how many remittance runs landed in the window, by source and status in plain words (for example ERA runs in window: 79 · Manual upload: 60 posted, 19 waiting to post, or Office Ally for clearinghouse files), and when the last one ran.
5. Expand the Revenue Overview for trends. The collapsible Revenue Overview has period buttons from 7 days to 12 months, summary cards such as Insurance Billed and Outstanding AR, a Claim Status Pipeline chart, and an AR Aging card with the same total and buckets as the AR Aging report. In Insurance and Hybrid practices it sits collapsed below the Monitor. In a DPC practice it is the Membership Overview (with Gross membership payments received · selected period (USD)), and in a Pure Cash practice the Collections Overview; there it comes first, expanded, with the Monitor below it, and the Monitor drops its claim stages when there is no claim activity.

Behind the monitor, automated checks sweep the whole pipeline nightly — unbilled insured visits, self-pay balances, stale in-flight claims, claim-integrity problems (duplicates, void confirmations, orphan charges, bookkeeping drift), payment-posting problems, claims a claim-file run had to leave out (see the claims pipeline), and statement, refund, and batch failures — and file each finding as a billing-inbox alert. The chips and the rollup are two views of that same alert rail.

Work the pre-visit billing readiness queue

The Pre-visit tab is the Upcoming Visit Readiness worklist — every scheduled visit in the next 14 days (by default), built to catch eligibility and insurance problems before the patient arrives. It has its own sidebar tab next to the Billing Monitor on the Dashboard. The header shows the date range plus Filters, CSV, and Refresh buttons. Dates and times — on the rows, in the drawer, and in the CSV — are in your practice’s time zone, providers show by full name, and your filters stay put when you switch tabs or reload, for the rest of the practice day.

The eligibility rule shown above the queue follows Collections & Fees → Insurance eligibility checks. Staff who manage billing settings can use Change to open it. Besides Re-check insurance eligibility after (30 days by default), that card has Check insurance this many days before a visit (1 to 30 days; 1, the day before, by default): Hero checks eligibility on its own for visits that many days ahead, so a failed check can be fixed before the patient arrives. It can’t be more than the re-check window, because older results are checked again anyway. A check someone on your team runs is never skipped. What happens when a check fails is up to your practice: see When an insurance check fails. When the practice enables front-desk paperwork, the Paperwork column shows None assigned, All done, or how many items remain, with their names. With add-card links enabled, authorized staff can use Send add-card link on a row without a saved card. Check the result message for whether delivery succeeded; the link saves a card without collecting money.

1. Scan the chip strip. Summary chips count Upcoming, Missing elig., Stale elig., COB missing, Open problems, and In progress, plus payer-class chips for Medicare, Medicaid, Private, and Unknown. The counts cover the date range and filters, whichever chip is on, and clicking a chip shows just those visits (it replaces any other chip filter). Hover a chip for its definition: Missing elig. — “No eligibility check on file for this visit’s primary policy.”; Stale elig. — the last successful check will be older than the practice’s re-check window by the visit date (30 days by default; a new calendar year also needs a check), and Hero re-checks these on its own “the day before the visit” (or as many days ahead as your practice chose, below); COB missing — “Another plan is on file, or eligibility named another payer, and there is no COB result yet.” The automatic re-check skips self-pay visits. Filters narrows by Start date, End date, Payer search (Aetna, BCBS…), Provider, Visit type, Payer class, eligibility status (Any eligibility), Problem (Any problem state / No problem / Open / Resolved), New patient (New patient only / Established only), and Secondary insurance (Has secondary / Primary only). Reset filters clears the lot.
2. Run eligibility checks. Each row’s Recheck button queues a live eligibility verification with the payer for the patient’s primary policy, through Stedi (or Optum, if your practice uses it for eligibility) — you’ll see Eligibility check queued. On rows without an active primary policy the button is greyed out — hover it for the reason (No active primary policy). Checks run in the background, so results don’t appear instantly; Refresh after a few minutes.
3. Read setup problems separately from patient problems. When checks can’t run because of your practice’s setup, the row keeps its real Missing or Stale badge with a small amber Not set up note, and one banner above the list explains it — for example “Eligibility checks aren’t set up · 3 upcoming visits couldn’t be checked. No eligibility clearinghouse is connected for this payer.” A policy whose last check failed back when Office Ally still checked eligibility reads Office Ally no longer checks eligibility; make sure Stedi eligibility is on and re-check. Admins get Open External Providers; everyone else reads “Ask your practice administrator to set this up in External Providers.” Problems with the patient’s own coverage still read Failed, in plain words rather than codes. An insurer that only answers checks dated close to today is not a failure: the row keeps its real Missing, Stale or active state with a neutral note instead of Failed, and the policy card a blue The insurer didn’t check that date notice, while Hero re-checks with today’s date once a day.
4. Run a COB check, and act on the answer. The row’s Run COB button (Run COB check ($1)) queues a paid coordination-of-benefits check against the visit’s primary policy — the same check, confirmation dialog, and cost as the one on the patient’s Insurance tab. It needs the COB permission (without it the button reads Ask a billing manager or office manager to run a COB check.) and an active primary policy, and it is disabled, with the reason on hover, when your practice can’t run COB checks (for example while the clearinghouse connection is in test mode, or with COB turned off). The same reason appears as a note above the list only when a visit in the current list actually needs an other-coverage check (its COB cell reads Missing or Failed) — for example “Other-coverage checks can’t run while your practice’s clearinghouse connection is in test mode. They work once the connection is live.”. The COB cell reads Not needed when nothing points to a second plan, and Missing (hover: Another plan is on file or Eligibility named another payer) when something does. While a check runs it reads Checking…; a check the payer refuses leaves Failed with the reason on the row. When a result finds other coverage the cell grows an amber Review order button that opens the same coverage-order dialog, so you can fix primary/secondary from the worklist without opening the chart. Once applied it reads Order applied.
5. Hold automatic charging when needed. For practices that charge saved cards before visits, the row’s auto-charge cell shows the next attempt (Next attempt in 3h), and Hold / Release stops or restarts automatic charging for that visit. Once the visit’s start time has passed the button is disabled — “This visit has started; automatic charging no longer applies.” The calendar’s right-click menu follows the same rule: Hold auto-charge… / Release auto-charge hold… and Waive pending deposit appear only before the visit starts, and Waive pending deposit also disappears once the patient has arrived (checked in, or joined a video visit, even early). A deposit the patient owes after arriving is handled on the patient’s billing instead — the refusal says “The patient has already arrived, so the deposit can’t be waived here. Use Invoices & Charges → Adjust / write off balance on the patient’s billing (needs sensitive billing access).”
6. Flag what needs a human. Flag (Flag billing problem) opens a dialog asking “What needs human resolution before this visit?” with Reason, Priority, and Notes fields; flagged visits later show Resolve. Both actions require billing AR permission (tooltip: Requires billing AR permission).
7. Open the detail drawer. Clicking a row opens a drawer with Visit & patient, Eligibility, Insurance policies, Coordination of benefits, Work items, Billing messages, and Billing notes — notes are visible to billing staff only. The Coordination of benefits panel repeats the determination and coordination order, lists what the payer reported, and carries its own Run COB check and Review coverage order buttons; it says plainly when a result is in hand but the chart’s primary/secondary order has not been updated yet. The check log reads in plain words — Checked, Failed, Staff review, Checking…, and triggers such as Pre-visit recheck, Appointment, New policy, and COB check.

A visit says “Billing path not set”

Billing path not set appears in the Billing part of a visit you open from the patient’s Appointments tab (Patient Information). It is common for a new patient’s first visit and is not an error by itself: it means the visit has an encounter but no claim and no charge yet, so Hero can’t say yet whether the visit is billed to insurance or paid directly. Nothing about the patient needs a setting called “billing path”.

The line changes on its own once billing happens:

• Billed to insurance once the visit has a claim (live or closed).
• Cash / direct pay once the visit has a charge but no claim.
• Billing starts once the visit has an encounter. for an upcoming visit, and No encounter was created for this visit. for a past one with no encounter.

1. Sign the note. Charges and claims are created when the provider signs the visit note (How billing works). An unsigned visit stays Billing path not set.
2. Check the patient’s coverage. If the visit should go to insurance, make sure the patient has an active policy on the Insurance tab (Insurance & eligibility). For a self-pay patient, Bypass insurance (treat as cash pay) prices the visit from the cash fee schedule, and signing won’t create an insurance claim.
3. Still not set after signing? Open the visit in Billing’s Claims Pipeline (the calendar’s appointment window can jump straight to it) to see whether its charges were held and why (Claims pipeline).

Review charges and run the claims pipeline

Charges created when a visit is signed and closed (see Charges & E/M) flow into the Claims Pipeline, which moves them from review through submission to resolution. The tab has four views — with clickable summary stats (needs review, ready, active batches, follow-up, stuck 25+ days) that jump you to the matching slice. Every view has the same search box (Search patient, MRN or claim #), and names match in any order (“First Last” or “Last, First”). In Flight and Resolved search every claim on the server, not just the page you have loaded, and also match partial names, the payer’s claim number (ICN), the clearinghouse claim number, and the payer name. Switching views, searching, or changing a lane keeps the page in place: the list shows Loading work items… or Loading claims… the first time; after that the current rows stay, dimmed, with Updating… beside the title, and change once when the answer arrives. An open claim that is still in the list stays open. In Flight says when it shows only part of the list — “Showing 50 of 132 in-flight claims. Search to find the rest.” or “Showing 50 of 70 matching claims. Narrow the search to see the rest.” Patient names open the Patient billing dialog (§5.7).

A claim file the clearinghouse never answered is flagged at the top of the Claims Pipeline for staff who manage claims, on whichever view you open first: “Claim file B2 has had no clearinghouse response for 17 days (7 claims).” / “Confirm with the clearinghouse before sending these claims again.” with Review claim file, or, for several, “3 claim files have had no clearinghouse response — the oldest for 17 days (21 claims).” with Review claim files. It is red when a file is eligible for recovery or already a delivery incident, and amber when it is only delayed. If not every claim file could be checked from there, it adds “Not every claim file could be checked here — open In Flight for the full list.” The button opens In Flight at the Clearinghouse delivery lane.

1. Review new charges. Ready to Submit splits into Needs Review — charges carrying issue badges such as coding or demographic problems — and Ready to Send. Fix the issue, then use Mark ready on the charge’s work item in the Action Center. A visit held because a code has no price reads No claim yet: 99050 has no price… with a Set a price for 99050 button (§5.4b). Cash-pay and self-pay charges, deposits, and patient fees never appear here.
2. Read how your claims are sent. Ready to Send opens with one line that says how this practice’s ready claims leave — the same sentence Claim Submission and External Providers show. For example: “Ready claims go to Office Ally SFTP in the daily batch. Next batch: today at 2:00 PM EDT.” (always in your practice’s time zone), “Ready claims go to Stedi automatically, about every 15 minutes.”, “Nothing is sent automatically. Select claims below and create a claim file to upload to your clearinghouse.”, or “Claims can’t be sent yet. …” with what is missing.
3. Send claims yourself. In Ready to Send, tick claims (or Select all) and pick the channel: Office Ally SFTP, Availity SFTP, Stedi, or Manual 837P download. The select starts on your route’s channel (or the first one that works), and a channel that can’t send yet says why — Not connected, Setup not finished, or Missing settings. The button follows the channel: Create Batch, Create Claim File (a downloadable 837P file for upload elsewhere), or Submit through Stedi. When nothing can send, the panel says “No way to send claims is set up yet.” and offers only Hold selected.
4. Hold claims. Hold selected opens Place submission hold. Held claims wait under Held (N), which follows the search box (No held claims match your search). The Held view also has an Insurer holds panel: Hold claims to an insurer holds everything going to one payer, and Lift hold ends it. Both dialogs leave the Follow-up date empty (“Leave empty for no reminder.”); the date you set is a date on your practice’s calendar, and for an insurer hold billers get an alert when it arrives. Hero also holds some claims by itself, with the reason in the note under the badge: for example Held · Awaiting review for a policy whose member ID and group number are the same, at a practice that sends claims only through Stedi (see Member ID and group number).
5. Track what’s in flight. The In Flight view lists batches with per-batch actions: Download 837P, submit to the channel, Mark manual portal upload complete, and Check acknowledgements. Each batch sums up its acknowledgements as one plain-language chip — Clearinghouse receipt ✓, Clearinghouse receipt ✗, or Clearinghouse receipt pending — instead of raw TA1/999 codes; the control numbers and raw acknowledgement text are still there for support calls, tucked into a collapsed Technical details disclosure inside the expanded batch. A batch the clearinghouse answered only with 277CA claim verdicts still counts as received (Clearinghouse receipt ✓; its tooltip adds 277CA: Received), and on the claim’s Submission box a file receipt that never came reads Not returned. Expanding a batch also shows the per-claim roster: every claim in the batch with a plain Accepted or Rejected verdict (no more ack-code legend to decode), the status message that came back, and a link that jumps straight to that claim’s Action Center item. A payer duplicate rejection reads Rejected with a Duplicate chip (“The payer already has a claim for this service. Check that claim before refiling.”). A claim moves through Draft, Ready, Submitted, Acknowledged, and In Process, then resolves to Paid, Denied, Partial, Pended, Appealed, Voided, Replaced, Removed at clearinghouse, or Closed (the Resolved view filters on each) — and a claim the clearinghouse bounced shows as Rejected, stays in this view tinted red, and carries a Correct & Refile button right on its row (the one exception is a rejected void — a claim you were cancelling has nothing to refile, so it reconciles from the batch view instead). A claim Hero couldn’t hand to the clearinghouse at all reads Submission failed. Rows also print the last submission error as readable text rather than hiding it behind an icon. A claim Stedi refused at its own checks shows Stedi’s code and wording, for example “33: The Subscriber Primary Identifier (NM1-09) and Subscriber Group/Policy Number (SBR-03) should not be the same. Correct and resubmit.” (see Member ID and group number); any member ID, group number, date or other value Stedi echoed reads [redacted], and a refusal recorded before Hero kept Stedi’s wording may read only its code and [redacted]. The status filter only offers statuses the view you’re on can actually contain. Claims with no activity for 25+ days raise an amber banner with a Review oldest stuck claims filter as soon as In Flight opens.
6. Watch for a claim file the clearinghouse never answered. The Clearinghouse delivery lane sits first in In Flight, above In Flight Claims. With nothing waiting it is a single line — Clearinghouse delivery · No uploaded claim file is waiting on a clearinghouse acknowledgement. with Refresh — and the Acknowledgement poller (separate from batch receipt) status under it. When files are waiting it shows a card for each uploaded batch that got no acknowledgement — batch number, a status such as Recovery eligible, Acknowledgement delayed, or Delivery incident, Uploaded — no acknowledgement, the clearinghouse, upload time, time elapsed, and claim count — with Release lost batch… to put its claims back to work.
7. Tell rejections from denials. Hero EMR treats these as different problems, because they need different responses. Submission failed means Hero couldn’t hand the claim over; fix what the error names and send it again. Rejected means the clearinghouse (or the transmission itself) bounced the claim before the payer ever processed it — no one adjudicated anything, so there is nothing to appeal; fix the underlying data and send a corrected claim with Correct & Refile. Denied means the payer processed the claim and decided not to pay — a real adjudication you work with Prepare appeal or Log Appeal, Resubmit as-is, or Write Off. Earlier versions of Hero EMR showed both as “Denied”; if you learned the pipeline then, the practical change is that a rejection is routine data-fixing on the way to the payer, not a lost decision.
8. Work the Action Center. The Action Center is a smart-sorted worklist across six lanes (table below). The lane cards across the top show each lane’s count, dollar total, and the age of its oldest item (oldest Nd) — so a lane that’s quietly aging stands out at a glance — and each claim row carries a readiness badge that leads with the first blocking problem by name — Patient ZIP code is invalid, say — with the issue count beneath it, so you know what to fix before you even open the claim (a claim with nothing blocking simply reads Ready). Each row’s reason line says what happened in plain words: on the Denied lane “Underpaid: Paid $121.60 of $190.38. $30.38 is unpaid and isn’t a contractual adjustment or the patient’s share.”, “Denied: Paid $0.00 of $190.38.” (plus what the patient owes, if anything), or “Line denied: Paid $150.00 of $190.38; a service line was denied.”, and once you log an appeal “Appealed: Paid $0.00 of $190.38. Appeal logged; waiting on the payer’s decision.” (a denied claim you write off leaves the lane); on the Rejected lane Rejected as a duplicate: … for payer duplicates; on the Pended lane the payer’s pend reason, else “The payer is holding this claim for review or more information.”; on the Fix lane the first blocking issue itself (for example Fix and submit: Patient ZIP code is invalid). A note you add shows under the reason as Note: …, and a claim appears once, not again as a separate charge row. Search by Search patient, MRN or claim #, sort by Smart sort / Newest update / Highest dollars, and narrow with My items, Include snoozed, or Group by lane. Selected claims take bulk Snooze selected / Flag; each item also offers Flag, Note, Assign me, Snooze, Mark ready (charges), and Mark uploaded (manual batches).
9. Resolve a claim. Expanding a claim shows Exact Problems (denial and rejection issues with codes, financial impact, and appeal deadlines — denial codes are decoded into plain language by a glossary the server builds from your payers’ actual responses, e.g. CO-16: “Claim is missing information or has invalid information.”; codes it can’t decode still appear with their raw code rather than being dropped), an Issues & fixes panel (the same readiness checks behind the row badge, each issue with its own fix button), Codes (editable diagnoses and per-line CPT/modifier edits with save-and-resubmit), Financials, Submission, and a Manual Submission Package with Show Raw 837P / Copy raw 837P / Download raw 837P. Denied claims offer Prepare appeal (the appeal kit, on unless your practice turned it off), Log Appeal, Resubmit as-is, and Write Off; partially paid (underpaid) claims offer Prepare appeal, Log Appeal and Write Off; rejected claims offer Correct & Refile, and Resubmit as-is while the claim never reached the payer. A rejected original claim you don’t intend to send again (for example a $0.01 tracking line) can be closed with Write Off (“Close this rejected claim without resubmitting it by writing off its balance.”); it needs the write-off permission, and a rejected replacement or void stays with Correct & Refile. When Medicare splits a claim and answers some lines on a separate notice, the claim reads Waiting for Medicare’s second notice as information, not as a problem, and the lines still to come are not counted as an underpayment. Log Appeal opens the Log appeal dialog: “Hero records the appeal here; it doesn’t send it. File the appeal with {payer} in its portal or by mail or fax, then log it here.” — with the appeal deadline when known, a required Reason for appeal, and an optional Payer’s appeal reference. Mark reviewed files a claim away in Resolved (“It comes back automatically if the payer sends anything new.”); for a denied claim it needs a Reason of at least 5 characters — why it needs no appeal, refile, or write-off — and any unpaid balance stays in insurance A/R until you write it off. Selecting several claims gives a bulk Mark claims reviewed prompt that requires the note when a denied claim is among them. Resubmit as-is is the action formerly labelled “Correct & Resubmit” — the new name says what it always did: it re-sends the claim unchanged, so make your corrections first. And buttons that aren’t available are no longer silently greyed out — hover a disabled Edit Codes, Regenerate, PDF editor, or Mark Manually Submitted button and a tooltip says exactly why (for example “Locked: this claim already reached the payer — use Correct & Refile to change it.”).
10. Fix demographics without leaving the claim. Patient-address problems — the most common reason a claim blocks or bounces — are now fixed in place. On the claim’s Issues & fixes panel, and on the blocker list inside the Correct & Refile dialog, demographic issues carry an Edit demographics button that opens the patient’s demographics editor right there, already in edit mode — no jump to the chart, no lost context. Save the correction and the claim, its row badge, and its worklist item all refresh on their own. Insurance issues carry Edit insurance or Add replacement policy the same way. Billers and billing managers get these fixes without chart access: billing staff who manage claims but not the full patient record get a trimmed editor limited to address and guarantor fields (which is all their save can change), and staff with the claims permission can add, edit, and expire policies. Links that would leave Billing for the chart or a note are shown only to users who can open them. When the practice’s claims route can’t send at all, the panel says Claims can’t be sent yet with the setting to fix — Open Stedi settings, Open Office Ally SFTP settings, or Claim Submission settings for admins, and “Ask your practice administrator to finish this in External Providers.” for everyone else. Once the data is right, a demographic issue on a claim that hasn’t reached the payer also offers Rebuild claim, which rebuilds it from the corrected chart; a claim that has already reached the payer routes through Correct & Refile instead, so payer tracking is preserved.
11. Correct & Refile a claim the payer has. Correct & Refile builds the corrected claim from the chart, shows it beside the original, and picks the kind of claim the payer will accept: a replacement, a new claim, a new claim with only the denied lines, or a claim to a different payer. It has its own section: Correct & Refile.
12. Trust what the claim-file viewer tells you. The raw 837P viewer labels what you’re looking at: Transmitted file from batch N for bytes that actually went out, Stored file (not yet transmitted) for a built-but-unsent file, Upload outcome unknown — this file may have reached the clearinghouse when a hand-off was interrupted, or Live rebuild — not yet transmitted. If the chart changed after the file was built, an amber banner warns that the file is not the current claim content, with a View current rebuild button beside it — so “the file still shows the old address” confusion is over. When a preview can’t be generated, the viewer prints the reason instead of failing silently, and the CMS-1500 preview does the same: blank boxes come with an explanation (for example “Address boxes are blank: the patient chart has no complete address on file.”).

Correct & Refile: send the claim the payer will accept

Use Correct & Refile when a claim has to change after it reached the clearinghouse or the payer. Fix the chart first (codes, the patient’s address, the insurance); Correct & Refile then rebuilds the claim from it, shows the original beside the corrected claim, and works out which kind of claim to send so the payer accepts it and the visit is never paid twice. Nothing is sent until you press the button at the bottom of the dialog. It needs the claims-management permission.

You open it from Correct & Refile on a rejected claim (its row in In Flight and its claim detail), from the fix buttons in a claim’s Issues & fixes panel when the fix needs a corrected claim, and from Prepare appeal when a corrected claim is the better answer to a denial. Billing Hero uses the same rules when it refiles a claim for you.

1. Choose the policy. Target insurance policy lists the patient’s policies with the payer, a masked member ID, the sequence and the status; the patient’s primary is marked current primary. Choosing a policy with a different payer turns the correction into a move to that payer (see below).
2. Compare the two claims. Original (as submitted) and Corrected sit side by side with the changes highlighted; a Member row shows each side’s masked member ID and relationship. If Hero no longer has the file that was sent, a note says the Original column was rebuilt from the claim record.
3. Read What will be sent. One sentence says which kind of claim goes out and why (table below), and the button at the bottom follows it. When the new payer prices the visit differently, Price change shows it, for example “Charge changes from $271.22 to $86.78 (Aetna contract rate)”.
4. Give a reason and send. Type the Reason for correction. Tick Hold for review before sending to keep the corrected claim in Ready to Send under Held until you release it. A correction with a code-pair or unit problem is always saved on hold (Save correction on hold): fix it or record an override on the corrected claim, then release it. The confirmation says where it went, for example “Held — release it from Ready to Send” or “Staged on hold — release it from Ready to Send when it is ready to go”.

Send a new claim with only the denied lines

When the payer split the claim, or denied some lines while it paid or hasn’t answered others, the dialog offers Send a new claim with only these lines: “Pick the lines it denied: Hero sends them on a new claim to the same insurance, and this claim keeps its other lines.”

1. Tick Send a new claim with only these lines. Each line shows its code and modifiers, what the payer did (Denied, nothing paid, Paid, Not answered yet, Partly denied, On another claim, or On a new claim not sent yet) and the billed amount. Only lines the payer denied in full can be picked.
2. Fix a modifier if the denial was about one. A picked line gets a modifiers box (empty reads No modifiers); for example, remove 51. Modifiers are the only change allowed on a line the payer already answered.
3. Press File new claim with these lines. The new claim goes to the same insurance. The original keeps its other lines; if you picked every line, the original is retired and stays in history.

Hero refuses a line, with the reason, when the payer paid it, hasn’t answered it yet (it may come on the payer’s separate notice), denied only part of it, put part of it on the patient (contact Hero support), when it was written off (reverse the write-off first), or when it is already on another claim the payer has. A new claim with only some lines can’t also split a charge, update prices or change the department, and it goes to the same insurance as the original; if the payer never got the original, correct the whole claim instead.

Move a claim to a different payer

A claim to a new payer is always staged on hold: “A claim to a new payer is always staged on hold first. Release it from Ready to Send after you review it.” Tick “File to {payer} as a new claim (frequency 1). The {original payer} claim stays in history.” to confirm. An unpaid charge is re-priced for the new payer, and Hero won’t file to a policy that isn’t in force on the date of service: a coverage panel shows Date of service, Coverage starts and Coverage ends, with Edit coverage dates.

• The original payer rejected the claim before processing it: nothing more is needed (“… rejected this claim before processing it, so no reroute record is needed.”).
• The original payer turned the claim back because it couldn’t find the member: a panel reads {old payer} turned this claim back and explains that the old payer never accepted the claim, so filing to the new payer can’t pay the visit twice. One button, File to {new payer}, records the old payer’s rejection as the reason for the move and stages the new claim on hold.
• The original payer reached and answered the claim: before staging, record why that payer isn’t responsible for the visit. Record routing denial asks for the Reason (Wrong payer, Not the responsible payer, Payer instructed a reroute, Coverage terminated before date of service), the Evidence source (Payer portal, Clearinghouse rejection, Payer phone call, Paper notice, Payer letter), a Note of at least 10 characters, and the details that kind of evidence needs (a reference, when you saw it, who you spoke to).
• The original claim is still open at the old payer: the panel reads Already filed to {payer} and lists Next steps: record the old payer’s $0 denial (I have a real $0 EOB from {payer} → Post $0 EOB, which needs the permission to post payments), or wait for its ERA. If the old payer paid, ask it to void the claim and take the payment back, then contact Hero support.

When Hero has no eligibility answer from the new payer for the date of service, confirm coverage from the patient’s card: fill in Where you confirmed coverage (for example Medicare card on file, Part B effective 12/1/2014) and tick “I confirm {payer} covered this patient on {date}.” If the new payer can be checked, run an eligibility check for that date instead. If its answer says the patient wasn’t covered, Hero won’t file the claim there.

Traditional Medicare

Original Medicare doesn’t accept replacement claims, so Correct & Refile never sends one there. What it does depends on what Medicare did with the earlier claim:

A replacement to traditional Medicare that was staged before this rule stays held, and a claim file leaves it out, with the same next step. Recording Medicare’s notice needs the claims-management permission.

When Hero can’t build the correction

• The dialog says why in plain words, and nothing is changed: for example “The corrected claim couldn’t be built, and nothing was changed. Try again, or contact Hero support if it keeps happening.”
• Edit insurance appears where the fix is the payer on the patient’s policy, and Edit coverage dates where the policy’s dates don’t cover the visit. Both open the Patient billing dialog on Insurance without leaving Billing, and saving rebuilds the preview.
• A replacement needs the payer’s own claim number. If it hasn’t arrived on an ERA, a Payer claim number (ICN) box appears: enter it from the payer or clearinghouse portal and press Save & rebuild.
• Member ID changed. A claim under a new member ID is sent only after the payer has answered the original without paying it. Until then Member ID changed — waiting on {payer} explains how to wait for the ERA or post the payer’s $0 EOB. If the payer paid the original, Member ID changed — {payer} paid the original claim tells you to ask the payer to void it and take the payment back, then contact Hero support.
• A coding change that would change the visit’s charge amount is refused, and so is a price update on a visit with money already posted. Undo the change, or contact Hero support to reprice the visit.

Choose the clearinghouse for claims, and fill in Manual 837P settings

The clearinghouse is chosen once for the whole practice, not per patient, policy or payer. That is why picking the correct payer on a patient’s insurance offers no clearinghouse choice: the payer decides where the claim is addressed, and your practice’s claims route decides which clearinghouse carries it. Administrators and staff with billing-settings permission set it in Billing → Configuration → Claim Submission.

1. Read the banner first. When Stedi or Claim.MD is the practice’s primary claims route, a line at the top says so (for example Claim.MD is the practice’s primary claims route.), with Open Stedi settings or Open Claim.MD settings for administrators, or An administrator changes this in Admin → External Providers → Stedi. That route sends ready claims automatically.
2. Pick the default. Default claim submission action lists the routes: Office Ally SFTP, Availity SFTP, Manual 837P download, and Stedi or Claim.MD when your practice uses them. A route that isn’t ready is greyed out with its reason after a dash (for example setup required); the cards below the setting show each route’s status, with Open setup for administrators or Ask your practice administrator to set this up in External Providers. When Stedi or Claim.MD sends ready claims, the hint reads “… sends ready claims, so this choice only applies to claim files you create yourself.” Press Save.
3. Fill in Manual 837P settings if you upload claim files to a payer or clearinghouse portal yourself. The Manual 837P settings card takes Submitter ID, Submitter name, Receiver ID, Receiver name, ISA qualifier and Receiver ISA qualifier (both start at ZZ and must be two characters), and a File name prefix, plus Test mode and Request TA1 boxes (both start ticked). Get the IDs and qualifiers from the portal you upload to. Press Save manual settings; Hero confirms “Manual 837P settings saved.” Until every required field is filled, the card lists them after Missing: and Manual 837P download can’t be chosen; once complete it reads Manual 837P generation is configured.
4. Send or download claims. In the Claims pipeline’s Ready to Send view you can still pick a route for the claims you tick, and In Flight offers Download 837P for a manual batch (Claims pipeline).

Connecting a clearinghouse is done in Admin → External Providers; for Stedi, see Stedi setup.

Bill a visit when the patient’s insurance is a plan you don’t accept

A practice can list the plans it doesn’t take in Admin → Practice Info → Insurance → Insurance we don’t accept (see Insurance we don’t accept). Each plan gets an action under When a patient has it. Flag only marks the patient’s plan Not accepted on staff screens and leaves billing unchanged. Treat as self-pay also changes billing, as below. With nothing on the list, nothing changes.

What billing does for a Treat as self-pay plan

• At signing. Charge capture starts the visit as Cash pay at the visit’s self-pay price, and no claim is made. The clinician can change it if the visit should still go to insurance.
• Claims are held, not sent. Any claim to the plan waits in the Claims pipeline’s Held (N) view. In the Insurer holds panel the plan’s hold shows Set in Clinic Information instead of Lift hold: change or remove the plan in Insurance we don’t accept to end it. A single claim can still be released from the held list when you decide it should go out (Claims pipeline).
• Collect from the patient. The visit’s charge lands on the patient’s balance like any self-pay visit. Collect it with Take payment or a payment link.

Post ERAs, manual payments & refunds

The Payments tab is headed Payment Posting, with Manual Entry, Post EOB, Upload ERA 835, and Refresh buttons across the top. It’s where insurance remittances and hand-keyed payments get applied to claims — and where refunds are issued. The tab opens on Payment Posting; the Overpayments & credit balances panel is the last section on the page (shown to admins and staff who can collect payments), and a chip beside the Payment Posting title — Overpayments & credits · 18 open · 3 overdue, or none open — jumps straight down to it. The panel tracks “Payer overpayments and patient credits the practice may owe back” until they’re returned: confirming a case starts its clock — 60 days for a payer overpayment (the legal deadline for Medicare and Medicaid, a work target for commercial payers) and 30 days for a patient credit — or you dismiss it. It has its own search (Search patient, MRN or claim #) and, with nothing open, shrinks to one line: Overpayments & credit balances · None open.

1. Upload an ERA. Upload ERA 835 accepts .835, .edi, and .txt files and posts them the same way remittances from your clearinghouse post; anything that needs a person waits in Unposted Remittances. The result says what happened — for example “Posted 3 of 4 claims (3 payments, 5 adjustments). 1 needs review — see Unposted Remittances.”, “Nothing posted: 2 of 2 claims need review — see Unposted Remittances.”, or “Nothing new to post — all 4 claims on this file were already posted.” A file that was already posted is never posted twice, and a claim that matches nothing in Hero is left for review.
2. Post queued remittances by payer check. Unposted Remittances holds “Remittances Hero hasn’t posted yet, grouped by payer check. Each one says why it’s waiting and what to do next.” Each check group shows the claim count, the payer’s check date and when Hero received it, and Check total, Not posted, and Posted (plus Other — money on the check that isn’t on a listed claim — when there is any); Post all ready (N) posts every ready row at once. Expand a group for its per-claim rows (Claim, Billed, Paid, Patient Resp, Status), with a note saying why the check wasn’t posted automatically. Each row’s status pill names its situation — Ready to post, Payer take-back, Cancelled out, Match service lines, Claim already paid, Claim closed, Claim voided, Money posted since, Patient share too high, and others — with a sentence saying what happened, and the row shows only the buttons that resolve it: Post, Map lines, Rebuild claim lines from charges, Post to claim of record (type a reason; the payment is recorded on the visit and inert duplicate claims are closed), Record payer reversal (shows what will change before anything posts), Reviewed — no posting needed, or Post anyway (after you tick “I checked: the money recorded since the hold is not this payment.”). If a Post is held after all, the row turns amber — Not posted — {pill}. {reason} — and the matching dialog opens. With nothing waiting, the card reads “Nothing is waiting — every remittance Hero received has posted.”
3. Post a paper or portal EOB. When a payer sends a mailed or portal EOB instead of an 835, Post EOB opens Post Insurance EOB. Pick the claim with the same live search picker, then key what the EOB says: Payer paid, Allowed, Patient resp. (total), Deductible, Coinsurance, Copay, and Contractual write-off, plus a Write-off CARC (e.g. CO-45), a Denial CARC (e.g. CO-16) with the Denied amount, the Payer claim # (ICN), Check #, Payment date, EOB date, and a Note. For an EOB that splits amounts by service line, Enter EOB amounts by service line takes them line by line; a half-filled denial row is flagged when you leave it or press Post EOB. Submit with Post EOB. A CARC-coded denial entered here starts the appeal clock just as an 835 denial would. If an electronic remittance for the same payment is already waiting in Unposted Remittances, Post EOB refuses with a red banner that names it — “This claim already has an electronic remittance for this payment that hasn’t been posted yet (check {check #}, {amount}). Post it in Payments → Unposted Remittances instead of keying the paper EOB.” (or, for one on hold, “… Resolve it there instead of keying the paper EOB.”).
4. Enter a manual payment. Manual Entry opens the Manual Payment Entry form: Claim # (required), Payment Type (Insurance Payment, Patient - Cash, Patient - Card, Patient - ACH), Payer, Check #, Amount (required), Payment Date, and Note — then Post Payment. The Claim # field is a live search picker — type a couple of characters of the patient, claim number, or payer and pick the claim from the results; no more pasting exact identifiers.
5. Reconcile the edges. Two collapsible panels keep the odd cases honest. External / filed outside EMR (N) lists remittance and status references that match no claim in Hero EMR — typically claims filed directly at the clearinghouse portal (Office Ally references like C###P##) — with source, payer, service date, and amounts, so money arriving for them is tracked instead of vanishing; at zero it still shows, with “No payer remittance or claim status has come back for a claim filed outside Hero.” Recent ERA Ingestion Runs shows “One row per 835 file, from your clearinghouse or an upload.” — received time, source (Office Ally, Stedi, Manual upload), status (Posted, Waiting to post, Needs review, Unmatched, Failed, and so on), and matched / posted / unmatched counts — your proof that remittances are actually flowing in.
6. Look up any check. Remittance History is the ledger of every payer check/EFT received, posted or not. Search by Check #, payer, or claim #, narrow with From / To dates and a status — Not fully posted, Posted, Partially posted, Needs review, or Unmatched, the same words the rows use —, and page through the results. Each row shows the Check date (the payer’s payment date, with a muted received date when Hero got it on a different day), check/EFT number, payer, method, check total, claim count, posted amount, and status — and expands into the per-claim EOBs behind that check, down to CPT-level adjudication. This is where you answer “did we ever get paid for this?”
7. Audit and refund. Recent Payment Activity lists the latest 200 payments with Date, Patient / Payer, Type (ERA-835, Insurance, Cash, Card, ACH), Check #, Billing Entity, Amount (with any Refunded sub-line), Claims, and Status (Posted / Pending). Refundable payments show a Refund action that opens the Issue Refund modal — remaining refundable balance, Refund amount, and Refund reason, confirmed with Refund Payment. Card refunds flow back through Stripe automatically.

Payment lines that did not match a claim: Work payment lines that didn’t match a claim.

Review and approve a refund that is waiting for staff

Some refunds wait for a person before any money moves. When a visit is cancelled and your policy says money goes back, the refund waits for staff review if your practice chose Staff approves each refund under Refunds after a cancellation in Collections & Fees, and always when the money was paid in cash, by check or on an outside card terminal. The Cancel Appointment dialog says so: “$20.00 waits for staff approval in Billing → Payments.”

1. Find it. Open Billing → Payments and scroll to Recent Payment Activity. The payment’s status reads Refund needs review, and its action column shows the reason with Awaiting review since {date}.
2. Review it. Press Review $X refund. Type the review outcome or reason (3 to 255 characters) and continue.
3. Confirm what happens to the money. For a card payment made in Hero, confirm “Submit the $X refund to the original payment processor?”; the message then reads “Refund completed.” or “Refund submitted; processor confirmation is pending.” and the status becomes Refund pending until the processor confirms. For cash or a check, first hand the money back, then confirm “Confirm you have actually returned $X in cash or by check. This records the return; it does not transfer money.”

A refund you start yourself, rather than one waiting for review, uses Refund on the same row (Payment posting). Membership dues refunds have their own flow (Memberships).

Download an ERA (835 remittance) or look one up

To download an ERA as a PDF, use the Received ERAs list. The Payments tab shows every remittance but does not offer a download.

1. Open Received ERAs. Open Practice Setup, go to the Stedi tasks step and press Open enrollment tracker, then choose the Received ERAs tab. Administrators and staff with billing-settings permission can open it.
2. Find the ERA. Filter with Received from and Received through, or choose All dates. Each row shows when it was received in Hero, the payer and payment, the claim counts and a status such as Posted in Hero, Needs review or Unmatched.
3. Download. Press Download PDF on the row. This also needs claims-management permission. A row reads PDF unavailable when there is nothing to download yet.

Look up a remittance without downloading

In Billing → Payments, Remittance History lists every payer check or EFT. Search by check number, payer or claim number and expand a row to read each claim’s EOB down to the service line. Recent ERA Ingestion Runs shows one row per 835 file received or uploaded. You can upload an 835 file you got elsewhere with Upload ERA 835 (Payment posting).

Match bank deposits to ERAs, and catch insurance payments that never arrived

Bank Deposits is a tab in Billing’s Operations group, right after Payments: “Match insurance deposits in your bank to their ERAs, and catch payments that never arrived.” Link the bank account where insurance payments land, or upload a statement from it, and Hero pairs each deposit with the ERA check or EFT it paid, then flags ERAs with no deposit and deposits with no ERA. This is bank reconciliation; it never moves money or changes a posted payment.

Insurance, hybrid and not-yet-set payment models show the tab; cash and DPC practices find it under Show all tools. Administrators see it. The practice owner and staff need the Bank Deposits permissions: one to see deposits, one to confirm or make matches and upload statements, and one, granted only by the owner or an administrator, to link or disconnect banks and change the settings. Anyone set to hide practice financials never sees it.

1. Connect the bank. In Bank accounts, press Link a bank and sign in to your bank in the secure window. The first sync reads First sync in progress; afterwards each bank shows Last synced … with Sync now (“New transactions show up in a minute or two.”). Each account has an Included / Left out switch, so a payroll or savings account can stay out of matching. If the card reads “Linking a bank directly isn’t turned on for Hero yet, so bank data comes from uploaded CSV statements.”, use the upload in the next step. Staff without the linking permission see “Ask your practice owner or an administrator to link the bank.”
2. Or upload a statement. Upload a bank statement (CSV) takes a CSV exported from your bank’s website, up to 5 MB, with an Account name (use the same name each time) and optionally the Last 4 digits of the account. Uploading a range you already sent adds only the new rows.
3. Read the summary. Pick the dates with From and To (the last 30 days to start). The tiles total ERA EFTs, Matched, ERAs with no deposit, Deposits with no ERA and Differences to review; click one to open that list. Match again reruns the matching.
4. Decide the suggestions. The lists switch between ERA checks (filters No deposit, Suggested, Matched, All) and Deposits (No ERA, Suggested, Matched, Amount differs (all), All; tick Insurance deposits only to hide other money). On a suggested pair press Confirm or Not a match; a suggestion whose amounts differ says so, for example Short $8.40. When several checks share one deposit, deciding one decides the whole group.
5. Match one by hand. On a deposit, Match… opens Match this deposit: “Pick the ERA check or checks this deposit paid.” Pick more than one when a payer paid several checks in one deposit. The dialog shows Amounts match exactly or the difference before you save.
6. Review a short pay. A deposit whose confirmed checks don’t add up to it is flagged under Differences to review. Once you’ve looked into it, press Mark reviewed (“Marking it reviewed accepts the $8.40 difference.”). It then shows quietly as Short $8.40 · reviewed.

See the deposit from Remittance History

In Billing → Payments → Remittance History, each check carries a deposit chip once your practice uses Bank Deposits: Deposited Oct 28, Suggested, No deposit (No bank deposit matches this check yet.), or the difference, which reads … · reviewed once someone has reviewed it.

Settings

Settings (for people who can link banks) opens Bank Deposits settings: Flag after (business days) (how old an ERA with no deposit, or an insurance deposit with no ERA, must be before it is flagged), Match window (business days) (how long after an ERA’s check date a deposit can arrive and still match), and Daily Billing Inbox alert, off by default: “Once a day, post one Billing Inbox item while any deposit or ERA is flagged.” Inside the waiting period an item reads Not flagged yet.

Capitation contracts: post $0 CO-24 lines as capitation, record monthly capitation payments, and compare expected with received

Use the Capitation tab when a payer pays you a monthly amount per member instead of per visit, for example an ACO or plan that passes a primary-care sub-capitation payment down. Without a contract, a visit the payer answers with a $0 CO-24 line looks like a denial. With one, Hero posts it as capitation: “A $0 line a contract covers posts as capitation, not a denial.”

Turn it on first. The tab is off by default. A practice administrator (or someone allowed to manage additional features) opens Admin → Additional Features, switches on Capitation contracts and saves. The tab then appears in Billing’s Configuration group, after Negotiated Rates. Administrators and the practice owner can do everything there. Staff need billing-settings permission to add or edit contracts, claims-management permission to record capitation payments and see the payment list, and sensitive-billing permission to close earlier CO-24 denials.

Add a contract

1. Start a contract. In Contracts, press New contract. Give it a Name, the Payer name and the Payer IDs as they appear on the payer’s remittances: “Hero matches a remittance to this contract by the payer’s name or any of these IDs.”
2. Say how the payer pays. Choose Sub-capitation (an ACO or plan passes a primary-care monthly payment down) or Full capitation. Fill in Starts, Ends (optional) and the Monthly rate per member (for example 30.00).
3. List the codes it pays for. Type or paste them into Codes the capitation pays for, or press Start from … to load a ready-made code set when one is offered. Check the list against your contract: only a $0 CO-24 line with one of these codes posts as capitation; any other CO-24 stays a denial to work. Tick any Specialties the payer pays separately.
4. Add the member roster (optional). Pick an uploaded roster under Member roster, or upload the payer’s member list (CSV or Excel, up to 5 MB) with the dates it covers. With No roster: every patient of this payer counts, every patient with this payer is treated as a member.
5. Leave the claim code off unless asked. Tick Mark claims to this payer as capitated (contract code CN1 05) only when the payer’s claim instructions ask for it. Press Add contract. To change or end a contract later, open it, edit and press Save; untick Active to stop using it.

Record and check capitation payments

• Payments on a remittance are added for you. “Capitation that arrives on a payer remittance (adjustment CT or CR) is added here automatically.” Their From column reads Remittance (CT).
• Record a check or payment file that came another way. In Capitation payments, press Record a payment, choose the contract, the payment date, the amount and the month it pays for, and press Save. A payment you entered can be removed with Remove; one from a remittance can’t. Use Show payments for to filter by contract, or Not assigned to a contract to find payments you still need to assign.
• Compare expected with received. Expected vs received shows, per month, the members, what the roster and rate should bring in, what arrived, and the difference (a shortfall reads, for example, $120.00 short). It needs the contract’s roster and monthly rate.

Close CO-24 denials that came back before the contract

Earlier CO-24 denials your contracts cover lists claims that were denied CO-24 before you set the contract up. Tick the ones to close and press Close N as capitation, then confirm. Each claim closes with its CO-24 booked as capitation and its denial and appeal reminder gone; the patient still owes nothing. This can’t be undone from this page.

Manage patient balances, statements & collections

The Patient AR tab opens the AR Workspace, which summarizes total outstanding (for example $1,601.51 across 10 patients) with Filters and Refresh buttons and a Search by patient name or MRN… box; practices with multiple billing entities also get a Billing entity switcher. Billing-inbox alerts about a specific patient deep-link straight here with that patient already filtered, so you land on the account in question rather than the whole roster. A toggle flips between three views — Aging, Day Sheet, and Invoices (the last one only for staff who may read patient invoices). Under the total, a second line splits the rest of what is owed: $A pending insurance · $B not filed yet · $C needs billing review · $D total receivable — the same figures as the Billing Monitor and the AR Aging report. Patient names open the Patient billing dialog.

1. Send a statement. Statement opens the Statement Preview — practice and patient addresses, line items with Charges / Insurance / You Owe columns, TOTAL AMOUNT DUE:, and a Due by date that follows the statement due days in Collections & Fees. Deliver it with Download PDF to print (records the statement and downloads the PDF — Hero never mails paper, so print and mail it yourself), Email payment link, or Email + download PDF. The message says which happened, for example “Statement recorded for {patient} — the PDF downloaded; print and mail it.” or “Statement emailed to {patient}.” A line whose share is held for a pending secondary claim ends “— waiting on {payer}”, is left out of TOTAL AMOUNT DUE:, and the preview adds “Pending other insurance: $10.00 (not due until the other insurance processes the visit)”. When nothing on the account is patient-billable, the statement actions are disabled with “No patient-billable balance — this balance is pending with insurance (including a secondary claim) or already settled, so a statement would be blank.”, and a bulk send skips that patient with the reason.
2. Send statements in bulk. In the Aging view, tick the checkbox on each row you want (up to 200 at a time), choose the method — Email, Download PDF to print, or Email + download PDF — and click Email statements (N), Download statements (N), or Email + download (N). Printing downloads one combined PDF. The result reports per patient — failures are named — and the failed patients stay selected so you can fix the issue (say, a missing billing email) and retry without double-sending anyone who already got theirs.
3. Open the billing timeline. The Timeline row action opens the Billing Timeline drawer: the patient’s outstanding balance and available credit up top, then the history grouped by visit, newest visit first (Visit Sep 12, 2026 · Office visit). Inside a visit, events read in order — charge, claim, payer payment, payer adjustment, then a Patient share from {payer} line that spells out the coinsurance, copay, and deductible the payer assigned — then the patient’s payments. Statements and account-level events sit under Account activity. It’s the fastest way to answer “what happened with this patient’s money?” without hopping between tabs.
4. Offer a payment plan. Plan opens Create Payment Plan with a frequency choice and installment preview. Plans record a schedule unless automatic collection is enabled and authorized for that plan. See Payment plans for setup, card authorization, and installment history.
5. Review fees and payment activity. On the Day Sheet, Fees opens the Fee Review modal listing no-show and late-cancellation fees generated by your missed-appointment policy, with a Waive Fee button that requires a waive reason (shown to admins and staff with the sensitive-billing permission); cancelling after you typed a reason asks before discarding it. The same fees can be waived from the fee’s invoice in Invoices & Charges with Waive fee. A fee is kept out of the money still on file for the visit (net of earlier refunds), so only the uncovered part appears as a new fee charge; and once a cancelled or no-show visit’s refund completes, its invoice reads Paid with an Appointment balance released line and the patient no longer shows that balance in Patient AR. Activity opens the Payment Activity modal — the receipts and credits hub: receipt numbers, amounts, refunded amounts, payment methods, a Statement history (delivery method and status per statement), and Issue Refund, Hold Credit, Apply Held Credit, and Release Held Credit actions. Refunds accept the separate refund permission or broader billing-adjustment permission; the credit actions still require billing-adjustment permission. Available credits auto-apply to future balances; held credits stay off the balance until you apply or release them.
6. Escalate to collections. Collections appears on an Aging row when the patient owes $100 or more and their oldest share is more than 90 days past due (hover: Owes $100 or more, more than 90 days past due) — the same rule as the Collections Warning status. It asks you to confirm sending the patient to collections, then moves the account into the collections workflow.
7. Prepare financial documents. Superbills, Good Faith Estimates, receipts, and statement PDFs live with the patient’s invoices — see Invoices & Charges.

Bill a guarantor: send statements to the person who pays

A guarantor is the person responsible for a patient’s bill, such as a parent paying for an adult child. Add the guarantor in the patient’s demographics, then choose whether statements go to them. Billing staff can do this without full chart access.

1. Add the guarantor. In Patient Information, open Demographics and edit. In the guarantor fields, set Guarantor relationship (Self, Parent, Spouse, Legal guardian or Other) and fill in the guarantor’s name, date of birth, phone, email and address. Self means the patient pays. Staff with the claims permission but not full patient-editing permission can change only the address and guarantor fields (Demographics).
2. Send statements to them (optional). Tick Send statements to the guarantor: “Emailed and printed statements and payment reminders go to {guarantor}, addressed to them, instead of the patient.” It is off by default.
3. Record the patient’s agreement. For an adult patient, choose How the patient agreed (Told us (verbal), Signed form (written) or Electronically) and the Date the patient agreed, then save. Hero records who entered it.

• The guarantor must be someone other than Self, with a name and an email or mailing address. Otherwise saving says “Choose who the guarantor is (someone other than Self) before sending statements to them.” or asks you to record the agreement.
• For a patient under 18 the box isn’t offered: “Statements for a patient under 18 already go to the parent or guardian.”
• While it is on, the statement preview and PDF read Bill to the guarantor and For the account of the patient. Staff statement emails, automatic statements and payment reminders all go to the guarantor. If the guarantor has no email, an emailed statement fails with a billing alert instead of going to the patient.

Run membership & subscription billing

The Subscriptions tab (under Programs in the sidebar) — “Manage recurring membership plans and patient billing.” — is the home of recurring revenue, and the primary billing workflow for DPC practices. All money movement runs through your connected Stripe account, so complete Stripe Connect onboarding first. Which visits a membership covers is set per service in the Service Menu (Membership coverage, §5.3), not on the plan.

1. Turn on subscriptions. The Subscription Settings card gates everything. With Enable subscriptions off, the rest is hidden behind “Turn on subscriptions to set payment, cancellation and access rules.” Turned on, it shows Allow patient self-cancel for portal self-service; Let patients undo a scheduled cancellation (until their paid period ends, a patient who cancelled can keep their membership from the portal); Members can finish portal setup with a balance due; the Grace period after failed payment; When cancelled, access ends — At end of billing period or Immediately; Access after a failed renewal; Messaging when membership access is restricted; the Booking exception; and Allow staff membership exceptions. The save bar reads No unsaved changes or Unsaved changes beside Discard and Save Settings. If Stripe Connect isn’t active you’ll see: “Stripe Connect is not active. Plans cannot be published until Stripe is configured in Admin > External Providers > Stripe.”
2. Build your plans. Under Membership Plans, New Plan opens the plan form — Plan name, Amount, Currency, an Every billing-interval selector, an optional trial, and Plan group (optional): “Plans in the same group appear to patients as one plan with a Monthly/Annual choice. Leave blank to use the plan name without ‘Monthly’ or ‘Annual’.” Plan groups only pair the monthly and annual versions of one plan — there are no household or family plans. Plan cards (for example v1 · Group: adult · Order 1) support edit, publish/unpublish, and archive; published plans list first, and archived ones stay out of the way until you press Show archived plans (N). Editing a published plan’s price, billing interval, or trial creates a new version for new enrollments; existing members keep their signup price.
3. Enroll members. Under Enroll a patient, use Find patient (or paste a patient ID), pick a plan, and send the enrollment link: Text link, Email link, or Copy link. The result says where it went (“Enrollment link texted to •••-1234.”, a guardian’s contact for a minor) or why it couldn’t send — for example the patient opted out of texts, there’s no mobile number or email on the chart, or they already have a membership. A patient without a portal account is asked to sign in first, so send a portal invite if they can’t. The patient completes checkout in the patient portal (see Portal payments). To charge a card the patient already saved instead, use Enroll with saved card; a declined first payment shows in amber with the card’s reason — the membership isn’t active until it’s paid — and raises a Membership payment failed alert in the Billing inbox. Unpaid first payments are cancelled automatically after about 2 hours.
4. Find and manage members. The Member Roster (“Monitor active subscriptions and resolve billing issues.”) lists Member, Plan, Status, Renews, Billing, and Actions, with a Search by name or plan box that finds “First Last” or “Last, First”. Above the table, Current (n) — the default — lists memberships that still run, past due, unpaid, and incomplete ones first, then active, trialing, and paused; Ended (n) holds memberships that have ended (an empty view reads “No ended memberships.”); All shows both. The search works inside the view you picked. Statuses read Active, Trial, Payment overdue, Unpaid, Paused, Setup incomplete, Setup expired, or Ended, and the Billing column names the latest invoice ($99.00 · Unpaid). Per-member actions: Details expands an Invoice timeline with per-invoice status and hosted Stripe invoice links; Cancel opens the Cancel membership modal with a proration/access preview, the Cancellation timing, a Reason (Patient requested, Payment issue, Plan fit, Staff review, Other), Notes, Email notification requested, and a Confirm access end date checkbox you must tick — cancelling doesn’t refund or prorate dues already paid, and a dues refund is a separate action described below. The dialog closes with its Close button, ×, Esc, or a click outside — asking “Discard unsaved changes?” if you typed Notes — and can’t be closed while the cancellation is running. Resume undoes a scheduled period-end cancellation; and Collect retries the open invoice immediately (enabled only while the latest invoice is open). Active and trialing members also have Change plan, End trial now (trials), and Pause payments / Resume payments (active members). A member who owes a payment — the same members the recovery queue lists — gets Payment link: Text link · Email link · Copy link under the row’s buttons, with the result line under it; paid members’ rows have no payment link.
5. Work the recovery queue. The Payment recovery queue highlights members with failed invoices, each with its status and the card’s decline reason (Setup incomplete · Your card was declined.) and Text link / Email link / Copy link to send the patient a payment link; rows flag Payment recovery needed, Cancels at period end, Plan no longer offered, and Snapshot needs staff review, alongside Stripe sync health. The queue doesn’t follow the roster’s view or search: it keeps every member who may owe a payment, including an ended membership that still owes. Staff with the access-override permission can use Record override to grant temporary access while billing is being fixed — care continues, the invoice gets chased.

Refund dues in Hero

In Subscriptions → Membership refunds and payment notices, an administrator or staff member with billing-settings permission can turn on Allow membership dues refunds in Hero and choose Save membership settings. It starts off. In a member’s Details, authorized staff choose Refund dues on a paid invoice, enter the amount and Reason for refund, then Review refund and Confirm refund. The dialog shows paid, refunded, pending, and remaining refundable amounts.

The refund returns to the original payment method without cancelling the membership or changing access. Wait for the recorded outcome; use Refresh refund status if it is pending or needs review. Invoice history retains earlier refunds after the practice turns the feature off.

Send payment-failure notices

In the same settings card, Email members when a dues payment fails starts off. Turning it on covers new failures, not the existing overdue backlog. Set Email send window in practice time, Days before grace ends, whether to Include the amount due in emails, and the practice wording. Preview email sends nothing; Save membership settings applies the changes.

Hero sends a failure notice, a reminder before grace ends, and an access notice only when membership-covered booking becomes restricted. Stripe’s retries and its own emails are separate. Staff who manage memberships can use a member’s Payment notice preferences to select Do not send payment notices or change Amount in payment emails.

Require a signed membership agreement

Under Subscriptions → Membership agreement, an administrator or staff member with billing-settings permission enters Practice agreement text, turns on Require a signed membership agreement before enrollment, and uses Save membership agreement. It starts off. One practice agreement covers all plans; Hero adds the selected plan’s price, renewal, trial, and cancellation details. Saving changed wording creates a version and does not automatically ask existing members to sign again.

1. Request the signature for the intended enrollment or change. Use Request agreement signature, then share the Secure signing link or send it using the available email/text controls. The authorized patient or guardian must sign before staff confirm an enrollment, plan change, or trial conversion that requires agreement.
2. Explain the patient’s step. In the portal the patient chooses Review membership agreement, reads the terms, accepts electronic signing, enters their name, and selects Sign agreement. Signing alone does not enroll the patient or charge a card. Complete the separate enrollment or change afterwards.
3. Check and retain the signed version. Use Refresh agreement status, Review agreement text, and Download signed agreement. The panel shows document and email-copy delivery separately; use Retry document or Resend signed copy when offered. Existing members can be asked to sign without changing their membership or charges.

More on memberships: Introductory offers and temporary member discounts and Registration fee and a later billing start date.

Bill the APCM program

APCM (Advanced Primary Care Management) is an opt-in module: the tab is absent until an admin enables it under Additional Features, and it shows only for users with billing dashboard or AR permission. Once on, it manages the full monthly cycle — enrollment, consent, care plans, and G-code billing — across four sub-tabs:

1. Watch the dashboard. The Dashboard sub-tab shows tier counts — Enrolled, G0556, G0557, G0558 — plus Monthly Revenue, an Alerts card, and an Upcoming Generation card with a month picker and Preview Generation / Generate Now buttons.
2. Enroll patients. Enrollments has three views: Enrolled (N), Pending review (N), and Eligible (N). From Eligible, select patients and click Enroll selected (N); from Pending review, bulk Approve (N) or Reject (N). Each enrolled row shows Tier, Chronic conditions, Last appt, Coordinating provider, Status, and Consent badges, with a Manage link to the enrollment detail. An auto-enrollment settings card can scan for eligible patients automatically or on demand (Scan now); the Eligible table shows Est. tier and Est. / mo revenue.
3. Capture consent. When you enroll or approve patients, choose a Consent method: Written consent (an e-signed agreement) or Verbal consent documented by staff. A sent invitation is still pending until the patient signs. The Consent badge on each enrollment reflects pending vs. obtained consent (with method and date), and the signed consent PDF files to the patient’s media tab.
4. Generate and track billing. Generate Now (or Preview Generation first) creates the month’s APCM billing events. The Billing History sub-tab lists them by month with Patient, Code, Amount, Status, and Generated columns and a Refresh button. Generated events flow into the normal claims pipeline as G-code charges.
5. Keep care plans current. The Care Plans sub-tab manages each enrollment’s plan — Goals with + Add goal, Interventions with + Add intervention, and Save Care Plan — and surfaces a Missing Care Plans list, since care-plan documentation supports the billed codes. When your practice has turned on Value-Based Care, this sub-tab opens the shared care-plan editor instead, with drafting from the chart, clinician review, and monthly approval — see Care plans.

Pay Hero’s invoice by bank account, and verify micro-deposits

Your practice’s own Hero invoices, and the bank account that pays them, are in Admin > Usage / Invoices → Payment Method. Administrators can open it; staff need permission to view Usage / Invoices, and only administrators and staff allowed to manage it can make changes (everyone else sees “You have read-only access to billing settings.”).

1. Connect the bank. In ACH bank account, press Connect bank account (or Update bank account). Add a Contact name first if Hero asks for one. A secure window opens: find your bank and sign in to it to verify the account instantly.
2. Read the result. “Bank account connected and verified — automatic invoice payments are ready.” means you are done. If your bank can’t be verified instantly, the account is verified with micro-deposits instead: “Micro-deposits were sent to your bank. Verify the amounts to finish (1–2 business days).”
3. Turn on automatic payment. Under Automatic payments, switch on Auto-charge invoices to charge the connected account when an invoice is due.

Verifying the micro-deposit amounts

Hero EMR has no field for typing the micro-deposit amounts. To finish, either:

• Press Update bank account and connect the same bank by signing in to it in the secure window, which verifies it instantly; or
• Contact Hero support to finish verification.

While a new account waits for verification, a bank that was already connected and verified keeps paying your invoices, so automatic payment isn’t interrupted. Invoices on the same page lists each invoice with View (opens it online) and PDF. Invoice emails go to the Contact email under Billing contact; press Save contact after changing it.