What comes in
Documented encounter
- Visit note available
- Services recorded in the chart
Coding & BillingIn beta
Turn documented care into claims ready to submit.
Caesar prepares coding from the clinical note and checks the claim before submission. Your billing team reviews exceptions with the source documentation close at hand.
- Checks the claim before it leaves
- Keeps coding exceptions visible to your team
See the work
A claim can move forward. Or stop for a reason.
Illustrative examples of a completed claim and a documentation issue that needs review.
What comes next
Checked claim
- Coding prepared from the note
- Payer edits completed
The claim can enter the configured submission workflow.
What Coding & Billing does
- 1Read note
- 2Prepare codes
- 3Check edits
- 4Submit claim
What comes in
Documentation gap
- Procedure recorded
- Required detail missing
What comes next
Coder review
- Missing detail identified
- Source note linked for review
The claim waits for clarification before submission.
What Coding & Billing does
- 1Read note
- 2Find gap
- 3Staff review
- 4Recheck claim
What it handles
Less re-keying between the note and the claim.
Coding & Billing is part of Caesar's Revenue Cycle agent. It handles the routine preparation so coders can focus on the claims that need judgment.
Read the documentation
Use the visit note and documented services to prepare diagnosis and procedure codes, with modifiers where applicable.
Check charge capture
Compare the documented work with coded charges and flag services that need a closer look.
Check payer requirements
Review the claim against configured payer edits. Surface missing details or conflicting information before submission.
Submit and track
Send completed claims through the supported clearinghouse connection and write the submission status back to your system.
Fits your practice
A clear path through the billing queue.
Configure the workflow around your specialty and payer mix. The claim should be supported by the record at each stage.
- 1
Read the visit
Pull the available documentation and encounter details from your EMR.
- 2
Prepare the coding
Map documented services to codes and compare them with the recorded charges.
- 3
Review exceptions
Route unclear documentation and complex coding to the right person.
- 4
Submit the claim
Send it through your supported connection after the required checks.
The record supports the code.
Your coders retain responsibility for coding judgment and exceptions. Missing documentation needs clarification. A billing code should never supply a clinical fact that the note does not contain.
- Human review for unclear or complex coding
- Payer acceptance and payment are not guaranteed
Keep your existing system.
We confirm the available connections and functions in your electronic medical record system, or EMR, before setup.
Check your EMR integration
Available functions vary by system and agent.
Before you start
Your questions, answered.
What to expect from Coding & Billing, and what your team controls.
How is this different from the full Revenue Cycle agent?
Coding & Billing prepares codes from the clinical record, scrubs claims and handles submission. It shares the Revenue Cycle platform with Prior Authorization, Denial Management and Payment Posting.
Does the Revenue Cycle agent replace our coders?
No. Coders retain clinical coding judgment and review exceptions or complex claims. Caesar handles routine preparation and checks under the rules your billing team approves.
What first-pass rate can we realistically expect?
The rate depends on your specialty, payer panel and documentation quality. Measure clean-claim acceptance against your own baseline during the beta rollout. A scrubbed claim can still be rejected or denied by a payer.
How does the Revenue Cycle agent keep up with payer coding changes?
The payer rules engine applies 200+ edits across medical necessity, bundling and modifier requirements, with updates as payer rules change. The supported rule set is confirmed for your payer mix before rollout, and unclear claims go to your team.
Which EHRs and clearinghouses does it work with?
It reads clinical documentation from supported EHRs including Epic, athenahealth, eClinicalWorks and NextGen. It creates 837 EDI transactions for submission through connected clearinghouses or payer systems and writes the status back to the practice management system.
Is the Coding & Billing function HIPAA compliant?
Yes. The Coding & Billing function runs on HIPAA-compliant infrastructure. Data is encrypted in transit and at rest. Caesar Health executes a Business Associate Agreement (BAA) at contract signing. SOC 2 Type II is in progress.
Which codes and claim checks does it cover?
The workflow uses current ICD-10 diagnosis codes and CPT or HCPCS procedure codes, with applicable modifiers. It checks documented services against charges and configured payer edits. Connected eligibility checks can flag coverage issues before submission.
Is Coding & Billing available now?
It is in beta. We confirm the specialty, payer requirements and supported connections before agreeing which claims the workflow can prepare and submit. Batch submission timing depends on complete documentation and required review.
How do we estimate the value of cleaner claims?
Use your claim volume, current first-pass acceptance and the staff time spent on rework. Compare those inputs with the results of your pilot, rather than assuming every corrected claim will be paid.
Coding & Billing
Walk through a claim with us.
See how a documented visit becomes a claim, including where your billing team reviews an exception.
Book a demo