Claims: Creating Claims

Within Doulado, you have the ability to create and submit claims to Medicaid, Private Insurance, TRICARE, and other medical reimbursement payers.

There are two methods to create claims: Direct Creation from the Billing Tab and from Billable Visits.

The Claims processing feature is only available if you are subscribed to a HIPAA Plan (Premium or Impact).  See Setup & Getting Started if you haven't set up claims yet.

Method 1: Direct Creation

  1. From the main Dashboard, click on Billing.

    On the left menu panel, go to Claims.

    Click on +New Claim and fill out the modal with the required information.

    Copy from logic:

    The claim form adheres to CMS-1500 standards, limiting each claim to 6 service lines. Multiple claims are needed for billing more than 6 visits.
    • Same Client: If copying from a previous claim for the same client, almost all data is duplicated (Diagnoses, Payer, Facility, etc.).
    • Different Client: If you copy from a claim belonging to a different client, the system only copies administrative and provider fields to prevent data leaks:
      • Federal Tax ID (TIN)
      • Accept Assignment status
      • Facility Information
      • Billing Provider details
  2. Once done, click on Continue to see the Claim Form on the next screen.

  3. All commonly required fields are highlighted in yellow, but it's better to fill out the claim form as completely as you can.

  4. Click on the Submit button on the right corner and confirm the submission in the pop-up.

Method 2: From Billable Visits

Before you can start a claim from a visit, that visit must first have a duration (as a result of having a End Date and/or End Time).

Billing Context:

  1. Navigate to Billing → Visits.
  2. On the right-side row actions, click on Billing and select Create Claim.

Client Context

  1. Navigate to Clients and choose a client profile.
  2. Switch to the Visits tab and click on Billing from the row actions.
  3. Choose Create Claim.

Both would open the Visit Billing modal with option to select up to 6 visits (each getting a service line) to use a blank or an invoice template.

Selectable Visits

The list automatically filters to show only relevant visits.

To appear in this list, a visit must:

  • Match Context: Belong to the same Client (Journey) and Provider.
  • Valid Status: Be Scheduled  , Confirmed, or Completed.
  • Billable: Have a billing status that is not Not Billable.
  • The visit must not already be attached to an existing claim.

Visit & Service Mapping Logic

When generating a claim from selected visits, on the claim form:

  • Each selected visit (up to 6) creates one service line, showing Date of Service
  • Service Code selection becomes available after choosing a Payer (If any Covered Services were added to the selected payer)
  • Units calculate automatically based on visit duration:
    • Time-Based: Uses the Medicaid 8-minute rule. See Time-Based Services for more information.
    • Quantity-Based: Defaults to 1 unit.
  • Amount = Units for the visit × Service Rate

See Covered Services for unit calculation logic and how services map to the CMS-1500 form.