Patient Pay
Feature Overview
⚠ OPTIONAL FEATURE
Patient Pay is not enabled by default. It must be manually added to the account by a developer or admin before it will have any effect.
What Is Patient Pay?
Patient Pay extends the billing validation system to cover claims that have reached patient responsibility — not just statements. When enabled, the system applies a set of readiness checks to patient-balance claims before they are allowed to move forward, ensuring the patient's address is valid, their payments are in order, their billing mode allows statements to go out, and that insurance has already paid what it owes.
How It Works Without This Feature
By default, these billing validations only run against statement records. Claims in patient-balance status are not checked. Patient Pay closes that gap by applying the same validation logic to claims where the patient owes the balance.
What Checks It Enables on Claims
When a claim reaches patient-balance status, Patient Pay enables the following automatic checks:
- Address Validation — Confirms the patient has a valid billing address. Flags issues such as unknown address, incomplete address, address not found, or unconfirmed address. Previously known bad addresses are also caught.
- Applied Payment Check — Verifies that all of the patient's payments are in an Applied status. If any payments are still pending or unapplied, the claim will not pass this check.
- Billing Mode Check — Confirms the patient's billing mode is set to Send Statements. Claims for patients in a suspended billing mode will not pass.
- Insurance Payment Check — Checks that insurance has already made a payment or adjustment on the claim charges before the balance is passed to the patient. Retail and balance-forward service codes are excluded from this check.
Heads Up
- These checks run automatically in the background — there is no button or action for users to trigger.
- Checks only apply to Medical claim types with a patient balance due. Other claim types and statuses are skipped.
- If the InboxHealth feature is also enabled on the account, these same checks apply there too — Patient Pay and InboxHealth share this validation logic.
- Address override flags are respected — if an address has been manually marked as overridden, it will pass the address check regardless of verification status.
Getting Access
This feature must be manually enabled on your account by a developer or admin. Contact your admin or support team to request access.