Billing & payers
Connect verified encounters to HMO and national scheme claims — pre-approval, code assist, quarantine, and payout tracking on the Curably Platform.
Last updated June 2026
Overview
Billing on Curably is anchored to verified encounters — not reconstructed invoices. Identity confirmation, visit open/close, and consent state feed the claims pre-check rail before adjudication.
Fraud is a consequence
Claims workflow
- Intake — verify beneficiary and scheme membership; attach payer identifiers
- Encounter — visit.started at check-in; clinical services documented in provider portal
- Coding — AI-assisted ICD/procedure suggestions; provider review required
- Pre-check — platform validates encounter evidence before claim submission
- Submission — export to payer API or batch file; track pending → paid → denied
Claims pre-check
The pre-check rail quarantines invalid submissions before they reach adjudication:
| Check | Failure action |
|---|---|
| No verification at facility | Quarantine — ghost patient risk |
| Visit not closed | Hold — incomplete encounter |
| Consent missing for billed service | Reject — scope gap |
| Duplicate claim same day/facility | Flag — anomaly review |
| Beneficiary not in scheme roster | Reject — eligibility |
/api/hmo/claimsHMO workspace: list claims with review state and timeline.
/api/hmo/claimsSubmit or update claim with encounter references.
HMO workspace
Payers and TPAs use the HMO workspace for network management, claims review, and program integrity:
- Network clinic registry and credentialing status
- Claims queue with approve / reject / request info / escalate
- Cross-network anomaly signals (platform AI capability)
- Audit intelligence exports for regulator reporting
Provider-side billing API: GET/POST /api/provider/billing
Reports
- Approval rate by payer, facility, and diagnosis category
- AR aging: 0–30, 31–60, 61–90, 90+ day buckets
- Denial reasons with encounter evidence links
- CSV and PDF export — see Reports & exports
Disputes
Disputed claims attach the full encounter audit chain — verification timestamp, consent scope, visit duration, and actor. Payers review evidence in HMO workspace rather than requesting reconstructed charts.