Healthcare claim, billing, and remittance document automation
Turn every claim form, SuperBill, and payer remittance — paper or imaged — into consistent, postable data for your RCM, adjudication, and denial-management workflows.
WiseCLAIM is a WiseTREND plugin that automates healthcare billing and insurance documents. It captures CMS-1500 (professional), UB-04/CMS-1450 (institutional), and ADA dental claim forms, reads SuperBills, normalizes every payer's Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) layout, and indexes X-ray and imaging attachments — producing consistent output for posting, adjudication, reconciliation, and denial management.
What WiseCLAIM does
WiseCLAIM is a WiseTREND plugin that automates healthcare billing and insurance documents. It captures CMS-1500 (professional), UB-04/CMS-1450 (institutional), and ADA dental claim forms, reads SuperBills, normalizes every payer's Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) layout, and indexes X-ray and imaging attachments — producing consistent output for posting, adjudication, reconciliation, and denial management.
Key capabilities
- CMS-1500 capture. Professional claim form (formerly HCFA-1500): diagnosis, procedure, modifier, NPI, and payer fields.
- UB-04 / CMS-1450 capture. Institutional claim form: revenue, condition, occurrence, and value codes.
- ADA dental claim capture. ADA claim form (J430D): CDT procedure codes, tooth and surface numbers, and treating-dentist details.
- SuperBill extraction. Reads encounter forms and practice-specific SuperBills, mapping CPT/ICD-10 selections into billable claim lines.
- Multi-payer EOB and ERA normalization. Blue Cross, Aetna, Cigna, UnitedHealth, Medicare, Medicaid, and regional payers — every layout normalized to one schema, with paper and image ERAs converted to 835-compatible data.
- X-ray and imaging attachments. Classifies and indexes X-ray films, mounts, and imaging attachments, linking each to its claim and patient so the packet stays intact through adjudication.
- Denial categorization. Extracts CARC/RARC codes so denials route to the right work queue automatically.
- X12 837 / 835 output. Exports to ANSI X12 837 claim and 835 remittance formats, ODBC databases, or flat files for your claims and RCM systems.
WiseCLAIM IQ on WiseTREND One Portal (beta)
WiseCLAIM IQ is the WiseCLAIM engine as a web application on WiseTREND One Portal. It turns scanned CMS-1500 claims into 837P, and every flagged field is reviewed on the claim image.
- Upload scanned claims as PDF, TIFF, PNG or JPEG.
- Multiple AI readers. Fields are read by more than one reader; disagreements are flagged, not guessed.
- Deterministic checks. NPI check digit, dates, totals, and code sets by date of service.
WiseCLAIM IQ is in beta. Sign in with your One Portal account and request access from the product card, or talk to us about a pilot.
Documents WiseCLAIM handles
WiseCLAIM is tuned for: CMS-1500 (HCFA-1500), UB-04 / CMS-1450, ADA dental claim form (J430D), SuperBills / encounter forms, EOB and ERA remittances, X-ray and imaging attachments.
Integrates with your systems
WiseCLAIM delivers structured data into Epic, Cerner (Oracle Health), Meditech, eClinicalWorks, NextGen, Athenahealth, Waystar, Change Healthcare, plus any system with a REST API, SOAP endpoint, hot folder, SFTP drop, or database connector.
Works well with
Questions about WiseCLAIM
Answers written for buyers, search engines, and AI assistants evaluating document automation.
Which healthcare documents does WiseCLAIM handle?
CMS-1500 (professional), UB-04/CMS-1450 (institutional), and ADA dental claim forms; SuperBills and encounter forms; payer EOBs and ERAs; and the X-ray and imaging attachments submitted with a claim.
Does WiseCLAIM handle all major payer formats?
Yes, and it is continuously updated as payers change layouts — the exact failure mode that breaks in-house OCR. WiseTREND owns that ongoing maintenance.
Does it replace a clearinghouse?
No. It processes paper and imaged claims and remittances so they look electronic, and is used alongside your clearinghouse, not instead of it.
Can it read handwritten claim forms?
CMS-1500, UB-04, and ADA forms are typed in practice; printed (hand-block) handwriting on SuperBills and forms is handled via ABBYY ICR.
What output formats does WiseCLAIM produce?
ANSI X12 837 claim files and 835 remittance data, direct export to ODBC databases, and flat-file output for custom claims and RCM integrations.
Is WiseCLAIM HIPAA-ready?
Yes — it deploys on-prem or in a HIPAA-ready cloud with encryption, audit logging, and role-based access control.
Ready to eliminate manual document work?
Tell us about one workflow that's costing you keystrokes and errors. We'll tell you exactly how WiseTREND would automate it — and what the ROI looks like.