First Pass Paid

Free tool · Self-assessment

Clean claim scorecard

Twelve questions across the front end, submission, posting and follow-up. Answers are weighted by how much money the gap usually costs. Nothing is stored unless you ask.

Front end

  • Is eligibility verified electronically before every single date of service?

  • Do you verify behavioral health benefits by CPT code, including carve-outs and visit caps?

  • Do you confirm each clinician is loaded on the payer roster, with an effective date, before their first billable session?

  • Are authorizations tracked with expiry dates and remaining units, visible at scheduling?

Submission

  • Do you have a report that flags claims approaching each payer's timely-filing deadline?

  • Are claims scrubbed against current NCCI edits before submission?

  • Do you have a documented, payer-specific modifier policy (telehealth, add-on codes, 25 and 59)?

  • Is the CPT and ICD code set refreshed annually in your EHR, with retired favorites removed?

Posting

  • Are ERAs posted automatically, with every 835 reconciled to a bank deposit?

  • Is each allowed amount compared to your loaded contracted fee schedule?

Follow-up

  • Is there a written SLA for working denials, for example, first touch within five business days?

  • Are patient-responsibility balances billed and followed up on a fixed cycle?

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