Billing & Claims Management
Automated online billing for CMS and commercial insurance — from claim generation to payment reconciliation, all in one place.
Claims Submission
Generate and submit claims to CMS and commercial payers.
Claims Tracking
Track claim status and payment progress.
Payment Matching
Match payments and identify discrepancies.
How intelligent
billing works
Cappa Health's billing engine automates the full revenue cycle for CMS-recognized programs—from eligibility verification and claim generation to electronic submission and payment reconciliation—all within a single integrated workflow.
Claims are generated using the correct CPT and G-codes for each program type (DPP, DSMES, hypertension, and more). Participant eligibility is verified in real time before submission, so denials are caught before they happen.
A built-in denial management workflow flags rejected claims, surfaces the reason code, and guides your team through correction and resubmission—turning revenue leakage into recovered reimbursement.
From enrollment
to outcomes
-
Eligibility verification
Patient insurance is verified in real time at enrollment — Medicare, Medicaid, and commercial plans — so billing is set up correctly from day one.
-
Automated claim generation
As participants hit billable milestones (sessions attended, weight loss thresholds, program completion), claims are generated automatically using the correct codes and payer rules.
-
Electronic submission & tracking
Claims are submitted electronically to CMS and insurance clearinghouses with full ERA/EOB tracking so you always know the status of every dollar billed.
-
Denial management & reconciliation
Denied claims are flagged with reason codes and routed for correction. Once resolved, resubmission is one click — and all payments reconcile automatically against your billing ledger.
Built for organizations
like yours
Health Plans & ACOs
Streamline member program billing and reduce administrative overhead with automated claim submission aligned to your fee schedules and coverage rules.
Health Systems & FQHCs
Capture every billable touchpoint across your CDC-recognized programs without adding billing staff — CMS reimbursement runs in the background.
Employer Benefit Admins
Simplify reimbursement workflows for employer-sponsored wellness programs and ensure accurate cost tracking against plan budgets.
Program & Finance Teams
Get a real-time view of total billed, total paid, active participants, and denial rates — with one-click drill-down into every claim.
Billing & Claims Management —
built for your organization
Talk to a Cappa Health health strategist about bringing this program to your population.