When does a claim count toward usage?
Starter counts production outbound 837 claims successfully transmitted to the clearinghouse. Pro and Premium count production claims accepted through an authoritative, exactly matched 277CA acknowledgment. Rejected, ambiguous, and accepted-with-errors responses do not count toward accepted-claim usage. A 999 acknowledgment, ordinary 277 status response, or 835 remittance alone does not count. Acceptance does not guarantee payment.
How do the usage rates work?
Starter’s rates apply only to claims within each graduated band. Pro and Premium use a flat accepted-claim rate from claim #1, in addition to the monthly subscription.
- Starter: 100 outbound 837 claims included. Claims 101-500: $0.50 each. Claims 501-2,000: $0.40 each. Claims 2,001+: $0.30 each.
- Pro: $0.50 per accepted claim beginning with accepted claim #1. No included accepted claims.
- Premium: $1.50 per accepted claim beginning with accepted claim #1. No included accepted claims. Clearinghouse processing included.
Are drafts and technical retries billable?
Drafts, previews, local spooling, failed uploads, exact technical retries, and SimpliClaim-caused duplicate submissions do not count as new billable claims. Intentional corrected, replacement, or void claims count when they independently meet the plan’s billable event.
What support do Starter and Pro include?
Basic SimpliClaim platform support covers account access, using platform features, and software problems. It does not include resolving payer rejections or handling claim issues with your clearinghouse. Those issues remain with your billing team and clearinghouse. Claim status, responses, and the software tools included in your plan remain available.
What does SimpliClaim handle with Premium?
Premium includes the platform, clearinghouse processing, and hands-on claim support. SimpliClaim handles payer rejection troubleshooting, trading partner coordination, and resolution follow-up. Your team works with SimpliClaim as its support contact. The price is $249 per month plus $1.50 for every accepted claim, starting with claim #1.
Contact us about Premium →
Who pays the clearinghouse?
With Starter or Pro, you keep your clearinghouse agreement and pay its fees separately from SimpliClaim. With Premium, SimpliClaim pays the underlying clearinghouse processing charge for covered claims as part of the $1.50 accepted-claim rate.