Understanding healthcare claims is essential for effective revenue cycle management in any healthcare practice. A comprehensive understanding of claim management helps ensure accuracy, reduce errors, and maintain compliance, ultimately leading to fewer denials and faster reimbursements. This article thoroughly examines the Canvas claim process, including superbill creation and usage, to empower practices to optimize their financial health.

User's Guide

Structure of the Claim

Claim Header

• Displays key patient and visit details. Actions such as changing queues, snoozing claims, or editing information from the triple dot menu are possible through the header.

• Click the patient’s name to navigate to their profile or the note link to access the associated note.

Claim Ledger

The claim ledger displays charges, payments adjustments and current balance for payers and patients. The ledger can be expanded by clicking on the + next to each payer or patient for a further breakdown by CPT

• Shows charges, payments, adjustments, and balances for payers and patients.

• Click the + icon to expand sections for a detailed breakdown by CPT codes.

  

• Hover over CPT codes to view original charge amounts.

  

As the claim continues through the claim lifecycle, the ledger is automatically updated with allocated amounts, payments and adjustments.

Charges & Diagnosis

The charges and diagnoses module enables viewing, editing, adding, and removing charges and diagnoses from the claim.

Selecting either the Charges or Diagnosis button will open the same modal, defaulted to the view that was selected.

Modifying a Claim

Adding a CPT Code to a Claim

Use the Add a Charge tab to input CPT codes, designate charges, and include essential details like date of service, units, and place of service

• View + Modify a CPT Code: Use the Charges tab to view existing CPT codes and linked diagnoses.

  • To modify, hover over the right side of a line item and select Edit charge details.

  

  • Make changes to any field and select Update to once the changes are complete

  • To remove a CPT code from the claim, click the Remove button to the right of the CPT code.

  • If a CPT code need a diagnosis code linked or unlinked to the code, click the link icon in the Diagnosis field

    

• View + Modify + Update Diagnosis Codes: Select the Diagnoses tab to reorder existing ICD-10 codes, add new or remove.

  • To make changes click the pencil icon on the right

    • To add a new diagnosis code, add the new ICD-10 to the empty field and click Add Diagnosis

    • To update an existing diagnosis, click into the box with the necessary code and type the new entry

    • To change the order of the diagnosis codes, click the number to the left of the diagnosis to open the dropdown and pick the new order

    • To remove a diagnosis code, click the Remove button

  • Once changes are complete, select Update. Clicking outside the box will lose all modifications.

Documents

Each claim has related documents including statements, receipts and remittances that can be viewed by selecting the paper icon under the claim ledger

Document Menu

• Receipts are generated for any patient payment activity, such as co-pays or balance payments.

  • Click the document 📄 icon and select Receipts from the dropdown.

  • The receipts modal will open with the patient's payment history

  • Click the blue PDF button on the needed receipt

  • The print preview will open to either print the document or save as a PDF.

• Statements can be generated adhoc from the documents menu. A defined outline of this process is found under Invoicing and Statements.

• Remittances are attached during automatic ERA processing or when an ERA is posted using Post a Remit.

  • Click the document 📄 icon and select Remittance from the dropdown.

  • The remittance modal will open with a list or remittances made on the claim.

  • Click the blue PDF button to review the remittance document

Superbill Document

A superbill is a critical document summarizing services rendered, diagnoses, and provider details for patient-facing billing or payer submission. It serves as a basis for reimbursement, especially for out-of-network billing.

• Ensure that all necessary CPT codes and ICD-10 diagnoses are correctly entered in the note or claim.

• From the triple dot menu of the claim header, click Print superbill

• Superbills include the following components

  • Patient Information: Name, DOB, and contact details.

  • Provider Information: Name, NPI, and practice details.

  • Date of Service: The date when the services were rendered.

  • Services Rendered: CPT codes and descriptions of the services provided.

  • Diagnoses: ICD-10 codes linked to the services.

  • Total Charges: Total amount billed for the services.

  • Practice Information: Address, contact information, and tax ID for billing inquiries.

HCFA/CMS 1500

The HCFA form is also known as a CMS 1500. The form allows medical physicians to submit health insurance claims for reimbursement from various government insurance plans including Medicare, Medicaid and Tricare.

• Click the triple dot menu of the patient's coverage.

• Select Print HCFA and choose whether to print with No background or with Claim form background.

• The print window open with a preview of the document. From here, the document can either be printed or saved as a PDF.

Visit Note

From the claim, it is possible to print the corresponding visit note.

• Click the triple dot menu of the note header

• Click Print note

• The print window will open with a preview of the note. Complete by printing or saving as PDF

Coverages

The Coverages section of a claim provides a clear and actionable overview of patient insurance details and their relation to the claim. It includes tools for managing coverages effectively to ensure smooth claims processing and payment allocation.

• Coverages will display on claims if the start date is on or before the date of service

• Show available coverage appears if additional active coverages exist but are not linked to the claim

  • If a new coverage is added to the patient profile after the creation of the claim or completion of its associated note, it must be manually linked to the claim.

Components of Claim Coverage

Each claim coverage displays the following information for all active coverages shown:

• Identify Active Coverage: Active coverage is highlighted in yellow and updates automatically as the claim progresses (e.g., when submitted to a secondary payer).

• Rank of Insurance: The order in which insurance payers are billed (e.g., primary, secondary, tertiary).

  • Click the triple line menu to the left of the coverage to change coverage positions

    The coverage position can also be changed under the Coverage heading of the patient profile.

• Insurance Plan Details: The insurance plan name, type, and associated payer ID.

• Policy Number: The policy ID for the linked coverage.

• Patient’s Eligibility Status: Confirms whether the patient is eligible under the listed coverage.

  • ✅: Insurance is eligible

  • ⚠: Error occurred running eligibility and requires further review

  • ❌: Insurance is not eligible

• Submission Status: Indicates whether the claim is submitted electronically or via paper.

Coverage Menu

Within the triple dot of each coverage, multiple actions can be managed

• Edit Coverage Details: Update plan details, subscriber information, or resubmission codes.

• View Insurance Card: Displays coverages card image, if applicable

• Remove Coverage: Selected coverage is removed from the claim

• Transfer Balance: Users can transfer balances to or from a coverage by using Transfer Balance.

Data Table

The claim data table includes easily referenced data including:

• Claim ID: This is sent to ClaimMD to link back to the patient when the ERA is received

• Provider NPI: NPI of provider assigned to the visit

• Guarantor: Person responsible for paying the patient balance

• Labels: Claim specific labels which can be created by following this process.

Activity Log

The Activity Log provides a chronological record of all actions related to a claim, offering transparency and aiding in troubleshooting.

• Access the log to view a detailed history of claim actions, including time-stamped entries and associated users.

  • When the author is Canvas Bot, update came in programmatically such as an ERA or a protocol that is in place

  • Some activity log items are collapsed by default, select see more.. to expand and see additional details

• Use the Post a Comment feature to document decisions or provide context. Comments include the author’s name and timestamp.

• Clicking the table headings will filter the log to its specifications

Snooze a Claim

Allows users to temporarily hide a claim from the primary outstanding claims queue. This functionality is particularly useful for managing claims that require delayed follow-up or additional information before action can be taken.

• Snoozing a claim sets a filter on the queue that temporarily removes the claim from the active view for a specified period.

  • Locate the Snooze option in the claim header.

  • Select the desired snooze duration

    • Preset timeframes: 3 days, 1 week, etc

    • Custom date: 1/28/2026

  • Confirm the snooze action to hide the claim from the default queue view.

• Once the snooze period ends, the claim automatically reappears in the queue for follow-up.

Claim Data

Now that we know how a claim is structured, lets review where data on the claim originates. Each claim has an associated note which has a patient, staff and practice location. This information populates the associated claim.

Patient Information

Patient demographics and coverage information originates from the patient chart and profile. When the associated note is locked, the claim is updated with any current patient demographic or coverage information at that time

• Patient data required for successful claim processing includes:

  • Name / DOB

  • Address

  • Phone

  • Sex at Birth

• Coverage data required for successful claim processing includes:

  • Coverage Name (linked to the payer ID)

  • Policy Number

  • Start Date

  • Coverage Address

  • Coverage Phone

  • Relationship to subscriber

  • Subscriber Information

Staff Information

When a provider is added into Canvas their staff profile must be populated with essential information to accurately populate a claim. Required information includes:

• Name

• NPI

• Group NPI

• Address and Phone - marked as use = work

• Tax ID

• Medical License

• Taxonomy Number (if applicable)

• CLIA Number (if applicable)

Modify a Claim

Claims are populated with the information reviewed above from the note, staff, and organization/practice locations. However at times, changes will need to be made to a claim. Within the triple dot of the note header or the triple dot of the coverage details, users can modify the populated information to support the needs of the individual claim

Edit Claim Details

Select Edit Claim Details to update any accident-related information:

• Motor Vehicle Accidents: Specify the state and date of injury.

• Employment-Related Injuries: Record the date of injury.

• Other Accidents: Select an Accident Code and date of injury.

Once you've made the changes, click Update to save.

Edit Patient Details

In the patient details form, the following fields can be updated:

• Patient's First, Middle, and Last Name

• Date of Birth (DOB)

• Sex

• Social Security Number (SSN)

• Phone Number

• Address

Edit Provider Details

In the provider details form, the following items can be modified:

• Rendering Provider

• Billing Provider

• Referring Provider

• Facility Information

After completing the changes, select Update to save.

Edit Coverage Details

Choose Edit Details on the coverage triple dot to modify the following sections:

• Coverage Details: Update information such as Plan, Group, Policy Number, Employer, Type Code, and Address.

• Subscriber Details: Modify Name, Sex, Date of Birth (DOB), Phone Number, and Address.

• Resubmission Code Details: Adjust Resubmission Code, Payer ICN, and set whether to display a corrected claim on the HCFA header.

Once all desired changes are made, select Update to save.

Claim Checks

Canvas performs basic claim checks every time a claim is loaded.  Claim checks help to ensure the claim is ready for submission to the clearinghouse.

Claim Processing

Submitting a Claim

• Move the claim to the Submission Queue.

• Claims in the submission queue are submitted to Claim.MD either:

  • Automatically via a scheduled daily process (setting will need to be configured for this process)

  • Manually by selecting Batch Actions and submitting to the clearinghouse.

If the clearinghouse rejects the claim immediately:

• The claim will move to the Rejected Queue.

• An explanation for the rejection will appear in the Activity Log for review and correction.

Claim Review Records (CRR Claims)

CRR claims are used when a provider associates more than 12 diagnosis codes with an encounter. The professional 1500 claim format supports only up to 12 diagnosis codes.

• Split claims can be reviewed within the charges modal of the claim, where diagnosis codes are grouped and associated with their respective CPT codes.

  • Group diagnosis codes and associate them with corresponding CPT codes in the Charges Modal.

  • Link ICD-10 Codes to CPT Codes: Each diagnosis code must tie to at least one CPT code to avoid errors.

  • Validate Diagnosis Codes: Before locking the provider note, ensure all diagnoses are linked correctly in the billing footer.

  • Avoid Duplicates: Do not reuse diagnosis codes across primary and CRR claims, as this may result in denials.

• Submit the CRR claim once it has been thoroughly reviewed. Confirm all diagnoses are appropriately ranked and linked to CPT codes to prevent processing errors.

Automated ERA Processing

ERAs (Electronic Remittance Advice) from ClaimMD are processed in Canvas, which includes preset adjustment groups and customizable Posting Rules for specific workflows.

After submission, claims stay in the Filed queue until adjudicated. Once processed, they move to the appropriate queue based on the outcome.

Handling Payer ID Mismatches During ERA Processing

When ERAs are received from a different payer than what appears on the claim (common with out-of-state routing), Canvas may skip processing with the message: "Skipped claim processing for #EFT [number] from [payer]: coverage with remit payer id not found in claim."

Resolution Steps

• Configure Alternate Payer Acceptance: Navigate to Settings > Insurers and select the original insurer on the claim. Update the Accept remittances from field to include the payer sending the remittance. This allows the original coverage to accept payments from the alternate payer.

• Update Patient Coverage (if needed): If the coverage name needs to change, expire the current coverage and create a new one with the correct insurer name. Simply changing the name on existing coverage will not take effect.

• Reprocess the ERA: Go to Settings > ERA process jobs. Click Process ERA in the upper right. Enter the check number from the remittance and click Send. This will reprocess the ERA and apply the payment to the claim.

Note: This process is particularly common with Blue Cross Blue Shield plans that route out-of-state claims to the appropriate regional plan for processing.

When to Use This Process

• ERA processing fails due to payer ID mismatches

• Claims are routed through different regional payers

• Out-of-state insurance plans process claims through local affiliates

• The remittance shows a different payer name than the original claim coverage

By default, Contractual Obligation (CO) adjustments go to the ADJUDICATED queue as write-offs. Custom Posting Rules can override this behavior for specific adjustment codes.

Payments and adjustments follow defined Posting Rules; if none apply, the claim moves to ADJUDICATED for manual review.

• HISTORY: No balance remains for any coverage.

• SUBMISSION: A balance remains for secondary coverage. As long as remit code 19 is not listed, the claim is forwarded to the secondary insurer.

• PATIENT: Only a patient balance remains.

• ADJUDICATED: Adjustments flagged for manual review.

• REJECTED: Claim rejected by the insurer.

Resubmitting a Claim

Resubmitting corrected claims ensures accurate reimbursement. To resubmit:

• Make necessary corrections to the existing claim.

• Click the triple dot menu on the coverage

• Select Edit Claim Details

  

• Choose an appropriate Resubmission Code, such as:

  • Corrected Claim

  • Replace Submitted Claim

  • Voided Claim

• Enter the payer ICN if available and enable the "CORRECTED CLAIM" header on the CMS 1500 form if required.

  

• Save changes, verify updates in the Activity Log, and move the claim back to the Submission Queue.

Create a Posting

When handling claim adjustments and payments, there are times when a posting must be created manually to reflect specific payment details accurately.

• Select a Payer: Choose from the dropdown and add a payment description for clarity, if helpful

• Enter Payment Details:

  • Amount

  • Payment Method

    • Cash: Enter the deposit date

    • Credit Card: Include the cardholder’s name and card number

    • Checks: Provide the check number, check/EFT date, and deposit date.

    • Other Methods: Simply add a description to identify the payment source.

• Add Adjustments: Select the appropriate Adjustment Type from the dropdown.

  • Adjustment types are categorized based on posting rules and include behaviors like Write-Offs, Transfers, or Non-Write-Off Adjustments.

    • Write-Off Adjustments: Use for contractual obligations or payer-initiated reductions.

    • Transfer Adjustments: Apply for deductible, co-pay, or coinsurance amounts transferred to the next payer.

    • Non-Write-Off Adjustments: Use for payer-specific reductions that require special handling.

  • If the adjustment deviates from the predefined posting rules:

    • Describe the reason for the deviation clearly in the Description field.

    • This ensures transparency and proper documentation for future reference.

• Save and Submit: Once all details are filled in, submit the posting. The payment and adjustment will now reflect in the Claim Ledger and appear in the Activity Log.

Correct a Posting

When an existing posting requires adjustments or corrections, the Correct Posting feature allows you to update payment or adjustment details accurately. This ensures the claim ledger remains up to date and reflects accurate balances.

• Locate the Posting

  • Navigate to the claim's Ledger section.

  • Expand the relevant posting by selecting See More next to the entry.

• Select the Correction Option

  • Click on Make Correction to enter the editing mode

  • The posting will switch to an editable table, allowing changes to specific fields such as payment amount, adjustment amount, or payer details.

• Edit the Fields

  • Update the necessary details. Common corrections include:

    • Modifying the Payment Amount: Adjust the payment to reflect the correct amount received.

    • Changing the Adjustment Amount: Revise incorrect write-offs or transfer amounts.

    • Updating the Payer Information: Correct errors related to the payer or remittance data.

• Validate Changes

  • After making updates, click Correct Posting to confirm the changes.

  • This action opens the Summary of Corrections modal.

• Review in the Summary of Corrections Modal:

  • Verify all details before submitting. The modal displays:

    • Type of Correction: Identifies whether it’s a payment or adjustment update.

    • Original Amount: Shows the previous value for reference.

    • New Amount: Displays the updated value entered during the correction.

    • Amount Corrected By: Highlights the difference between the original and new amounts.

• Submit or Reset:

  • Submit the Correction: If the corrections are accurate, select Create a Posting to finalize the changes.

  • Reset the Changes: If there are discrepancies, click Reset to discard the edits and revert to the original values.

• Confirmation and Activity Log Update:

  • After submission, the corrected posting is saved and reflected in the claim ledger.

  • The Activity Log records the correction, including details of the changes, the user who made them, and the time of the update.

Post a Remittance

For claims that are not automatically processed via an Electronic Remittance Advice (ERA), the Post a Remit feature allows users to manually record payments and adjustments. This ensures the claim ledger remains accurate and up to date.

• Access the Post a Remit Form:

  • Navigate to the Revenue section and click the green Post a Remit button to open the Post a Remittance form.

• Enter Payment Details

  • Input essential payment information, including:

    • Payment Amount: The total amount received from the payer.

    • Check Number or EFT Number: Unique identifier for the payment.

    • Insurer/Payer Name: Select the payer responsible for the remittance.

    • Payment Method: Choose from available options:

      • Credit Card

      • Check/EFT

      • Other

• Attach Digital Documents (Optional)

  • Upload a copy of the remittance advice or related documentation for reference.

  • This ensures easy retrieval and supports future audits.

• Link the Remittance to Claims

  • Select + Add a Claim to associate the payment with one or more claims.

  • In the Find a Claim modal:

    • Search by patient name or Claim ID

      • Only claims with active coverage linked to the selected insurer will appear.

    • Review details, including claim ID, date of service, patient name, provider, charges, and current queue status.

      • If needed, click on the Claim ID to view more details in a new browser tab.

    • Click Select on the appropriate claim to link it to the remittance.

• Allocate Payments and Adjustments

  • Once the claim has been identified and selected the correct claim, the Record Claim Payments and Adjustments modal will appear.

    • Enter the payment description (optional).

    • Specify payment and adjustment amounts.

    • Select the Adjustment Type (e.g., write-off, transfer, non-write-off).

    • If a balance remains:

      • Designate where it should be transferred (e.g., to the patient or secondary payer).

      • Use the Write-Off checkbox if applicable.

  • For claims with multiple codes, add or remove adjustment lines as needed.

  • Choose to either automate the claim’s movement to the appropriate queue or manually set it

• Submit the Claim

  • Prior to submitting, ensure the recorded payments match the total payment amount on the remittance. Click Submit to finalize the remittance, and the claim will be updated accordingly.

Invoicing & Statements

Creating a Statement

Patient statements are vital for collecting outstanding balances and providing clear communication about payments owed. Canvas Medical offers several options for generating and distributing these statements, ensuring flexibility for various practice needs.

Methods for Generating Statements

• Manual Batch Processing: Generate statements in bulk, ideal for end-of-cycle processing or managing large batches of outstanding balances.

  • To create batch statements:

    • Navigate to the Statements Batch Processing option in the Revenue section.

    • Select and process all eligible statements based on your criteria.

  • This method is perfect for periodic billing workflows or addressing multiple accounts simultaneously.

• Automated Processing: Send statements via email or physical mail programmatically.

  • This set up will need to be configured by the practice's admin. See Automated Invoicing below for configuration process.

  • Patients will need to have a valid email and/or postal address for statements to send successfully.

• Ad-Hoc Printing: Allows users to print individual statements directly from a patient's record for streamlined access.

  • This feature is ideal for urgent or on-demand requirements during patient interactions, such as visits or follow-ups.

  • Statements can be quickly generated from either the patient profile or the claim section within the system.

    • Select the document icon 📄 to access the statement options.

    • Choose Statement from the dropdown menu.

    • Click Create Statement in the Statement modal to generate and download a new PDF version of the statement.

Setup & Configuration

Configuring Organization and Practice Locations for Billing

Practice locations in Canvas can populate claims with location-specific information or select Bill through organization in the Practice Location setting, which defaults to the information captured on the organization profile. Required information includes:

• Full & Short Name

• NPI

• Tax ID

• Address

• Phone

If notes require a different name, NPI, taxonomy or address this can be completed on the Practice Location profile

• Billing location name

• Group NPI number

• Taxonomy number

• Address / Phone with use = billing

On the practice location, there is the option to Include ZZ qualifier for taxonomy code when submitting a claim. When checked, the claim will automatically include the ZZ Taxonomy Qualifier.

Box 33a and Box 32a

Box 33a and Box 32a serve distinct functions on the CMS 1500 form.

• Box 33a is designated for the Billing Provider’s National Provider Identifier (NPI), sourced from the Group NPI on the organization’s configuration page, and is mandatory.

• Box 32a is used to input the Service Facility NPI and is only required when it differs from the Billing Provider’s NPI.

  • If a provider's individual NPI needs to be included in Box 32a, this can be accomplished by creating a new location with the specific details or updating these details in the provider profile.

Creating a Posting Rule

Posting rules help manage adjustment codes to monitor payments and adjustments efficiently. Canvas provides preset adjustment groups, but users can add customized posting rules to suit their workflows.

• Regularly updating the posting ruleset can reduce manual work and keep rules relevant.

Adding a Posting Rule

• Navigate to the Quality & Revenue: Posting Rules setting

• Click the Add Posting Rule +

• Complete the fields

  • Description: How the posting rule will display in Canvas

  • Adjustment Group: Explains the adjudication of the claim

    • Contractual Obligation

    • Other: Adjustment

    • Payer Initiated Reductions

    • Payer Responsibility

    • Collection Write-Off

    • Courtesy Write-Off

    • Credit

    • Transfer

  • Adjustment Code: Reason a claim or service line was paid differently than it was billed.

    • To review a list of all common adjustment codes visit X12.org

    • Individual payers may have specific posting rules as well.

  • Behavior: Action when posting rule is used

    • Write off adjustment

    • Non write off adjustment

    • Transfer adjustment to next payer

  • Payer Order: Which payer to apply the posting rule to

  • Transactor: Specific insurer the posting rule applies to

  • Automated Action Review: Posting rule will automatically apply to claim when applicable

Updating a Posting Rule

• Navigate to the Quality & Revenue: Posting Rules setting

• Select posting rule that needs to be updated

• Make any necessary changes and save

The following posting rules are created by default in all environments:

Configuring Automated Invoicing

Enable Automated Invoicing

• Contact Canvas Support to request activation of automated invoicing for the practice.

Configure Initial Delay After Service Date

• The delay for sending the first invoice can be customized in the Practice: Organizations settings

  • Update the patientInvoiceSendDelay configuration with a specific value, such as {"days": 0}.

  • Default setting: 0 days, which ensures invoices are sent immediately after the service date.

  • Practices can increase the delay period to allow a grace period before patients receive their first invoice.

• Important Callouts

  • The send delay is based on the date of service, not the date when the balance was transferred to the patient.

  • Invoices are sent to all patients with an outstanding balance, regardless of the billing queue.

Set Frequency of Sending

• Adjust the frequency for reissuing statements by updating the INVOICE_INTERVAL configuration available in Constance: Config.

  • Defines the interval at which subsequent statements are sent after the initial invoice is dispatched.

  • Default: 15 days

  • Modify the interval to reflect the practice’s specific billing cycles and operational preferences.

FAQ

Q: Why was my claim returned to the coding queue?

A: When notes linked to claims are unlocked and then relocked, an automated process moves the claim back to the coding queue. This ensures that any billing changes are accurately reflected on the claim.

Q: Where do I find a remittance document?

A: The remittance document is accessible in the document icon below the claim ledger and in the posting itself.

Q: What should I do if a claim is listed twice in a remittance?

A: If a claim appears more than once in a remittance, no transactions will be recorded for the duplicate entry, and the Canvas Bot will add the following comment: “Skipped processing duplicate account number in remit.”

Q: What happens if I accidentally manually post an ERA?

A: You can manually post an ERA as many times as you'd like, but Canvas will not create duplicate postings on the claim.

Q: Why is a claim in my adjudicated queue?

A: All claims that have an adjustment code that is part of a ruleset where automated action review is checked will display in the adjudicated queue for manual completion.