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How To CTRL ENTER
Not sure what questions to ask? Start here. These are some real examples of how teams use it every day—from front desk tasks to billing and clinical support. Try them out, tweak them, and discover how much faster your workflow can be with just a few words.
Patient and Balance Information
CTRL ENTER analyses patient information on your screen or from any source document provided.
The current patient balance refers to the portion the patient is responsible for after insurance has processed claims. This includes copays, deductibles, coinsurance, and any remaining balances after insurance adjustments.
To determine the exact amount owed:
- Review the patient’s ledger or account summary in your billing system.
- Confirm whether there are any open claims still pending insurance review.
- Check if any recent payments have been posted or if a payment plan is active.
- Note whether there are outstanding statements or collections holds.
Once reviewed, you’ll be able to provide the patient’s current balance due, as well as explain what the charges are for and whether insurance has already paid its portion.
John Doe has 10 claims.
Claim 1
Claim 2
Claim 3
Period Totals
- Billed: $500.00
- Allowed: $300.18
- Insurance Paid: $217.74
- Patient Responsibility: $54.44
- Denials: 1 (Metabolic panel denied as not medically necessary)
If needed, I can help review the denial for 07/15 and recommend next steps.
The claim for the 09/10/2025 date of service was denied due to missing prior authorization. The payer listed denial code 197: Precertification/authorization absent.
This means the service performed required prior authorization under the patient’s insurance plan, but no authorization number was submitted with the claim.
Recommended Next Steps:
- Confirm whether prior authorization was actually obtained.
- If it was, locate the authorization number and resubmit the claim with supporting documentation.
- If authorization was not obtained, you may need to complete a retro-authorization request with the payer (if allowed).
- Document the follow-up activity in the patient’s account.
CTRL ENTER fetches information about any patient within your system, calling the patient search, patient statement, claim list, and claim details as needed
[MCP Query: Patient Ledger → MRN: 004291]
[MCP Result:
Total Charges: $1,045.00
Insurance Payments: -$762.50
Contractual Adjustments: -$148.50
Current Patient Responsibility: $134.00
Last Statement Sent: 2025-02-03
]
[MCP Query: Check Pending Claims → MRN: 004291]
[MCP Result: No active claims pending payer adjudication]
[MCP Query: Payment Plan Status → MRN: 004291]
[MCP Result: No active payment plan on file]
Current Balance Due: $134.00
This amount reflects:
- Coinsurance from visit on 01/22/2025
- Remaining deductible application on lab panel 80053
- No outstanding insurance activity is expected; the balance is fully patient responsibility.
If needed, I can also:
- Send a secure statement
- Set up a payment plan
- Take payment
- Or send a text/email to the patient with the amount and payment link.
Just tell me which you’d like to do next.
[MCP Query: Claims → Patient: John Doe → Date Range: 2024-07-01 to 2024-07-31]
[MCP Result:
CE-2024-0702-00087 | 99213 | J06.9 | Aetna PPO | Billed $160 | Paid $78.40 | Pt Resp $19.60 | Status: Paid
CE-2024-0710-00144 | 93000 | R07.9 | Medicare B | Billed $75 | Paid $33.74 | Pt Resp $8.44 | Status: Paid
CE-2024-0715-00203 | 80053 | Z13.6 | UHC Choice | Billed $55 | Denied (CO-50) | Status: Denied
CE-2024-0728-00311 | 99214 | M54.5 | Cigna OA | Billed $210 | Paid $105.60 | Pt Resp $26.40 | Status: Paid
]
[MCP Query: Denial Detail → Claim: CE-2024-0715-00203]
[MCP Result: CO-50 – Not medically necessary for submitted diagnosis]
Summary
- Total Billed: $500.00
- Insurance Paid: $217.74
- Patient Responsibility: $54.44
- 1 Denial requires review (07/15 CMP).
-
[MCP Action (optional): Create Work Queue Task → "Review clinical justification and resubmit appeal for CMP denial on 07/15"]
[MCP Action (optional): Attach clinical notes + ordering provider documentation for re-review]
I can auto-prepare the appeal packet if you'd like.
Just reply: "Appeal it."
[MCP Query: Claims History → MRN: 12345 → DOS: 09/10/2025]
[MCP Result: Denial Code 197 — Prior Authorization Missing]
[MCP Query: Authorization Records → Patient: MRN 12345 → DOS: 09/10/2025]
[MCP Result: No prior authorization found]
[MCP Action: Create Task → Billing Work Queue → “Request Retro Authorization from Payer”]
[MCP Action: Document account note → "Claim denied 197. Retro auth needed. Task assigned to billing."]
The claim was denied because prior authorization was not on file.
I’ve:
- Confirmed no authorization exists,
- Created a billing task to request retro authorization,
- And documented the note in the patient’s account.
Eligibility and Benefits
CTRL ENTER reviews the coverage details you provide or reference from what’s already visible on screen.
It helps interpret deductible, copay, coinsurance, visit limits, and referral requirements, and explains what the patient owes in clear terms.
- Patient: Jane Smith, DOB 1986-04-12
- As of 2025-11-07, Eligibility: Active, Plan: BlueVista EPO (Group BV-8821), Member ID BV-S12345.
- PCP on file: Dr. Patel, effective 2025-05-01.
- Coverage exclusions noted: None; ER and urgent care covered in-network only (no OON benefits except emergency).
Recommendation: Capture a copy of the card, confirm PCP assignment if required for referrals, and schedule as in-network.
Coverage details for a 99213 office visit depend on the patient’s specific plan benefits.
Typically, you’ll want to check:
- Deductible status (how much has been met so far)
- Copay for primary care office visits
- Out-of-pocket maximum (OOP) and remaining amount for the year
Example (dummy data for member ABC123):
- Deductible: $1,500 annually
- Met so far: $900
- Remaining deductible: $600
- Copay for 99213: $25 per visit
- Out-of-Pocket Max: $6,000 annually
- Amount met: $2,450
- Remaining OOP: $3,550
This means the patient will owe the $25 copay at the time of their visit, assuming the deductible does not apply to office visits under this plan.
If the plan applies deductible before copay, the patient may owe more depending on allowed amount and deductible remaining.
Whether physical therapy (PT) requires prior authorization depends on the specific insurance plan, not just the insurance company. Many commercial and Medicare Advantage plans require prior authorization after a certain number of visits or for certain CPT codes.
How to check:
- Verify the patient’s benefits through the payer’s provider portal or your clearinghouse.
- Look specifically for:
- Outpatient Rehabilitation / Physical Therapy services
- Visit limits (e.g., 20–30 visits/year)
- Authorization triggers (e.g., after the 6th visit or for codes 97110, 97112, 97140, 97530)
- Confirm if medical necessity guidelines apply (often based on progress notes and functional improvement).
If authorization is required, be sure to:
- Submit the initial evaluation and supporting documentation
- Track the number of visits used
- Obtain renewal authorizations if needed
CTRL ENTER directly retrieves real-time eligibility and benefits from within your connected systems. It queries payer eligibility, benefit accumulators, visit caps, prior authorization rules, and out-of-pocket tracking, then documents the verified benefit details in the patient record automatically.
[MCP.eligibility.verify(name="Jane Smith", dob="1986-04-12", payer="BlueVista", as_of="2025-11-07")] → status ACTIVE
[MCP.member.profile.get(member_id="BV-S12345")] → PCP=Patel, effective 2025-05-01
[MCP.save.eligibility_snapshot(patient_id="PT-22991", date=today)]
[MCP.frontdesk.ticket("Verify co-pay and referral requirements for EPO visit", patient_id="PT-22991")]
[MCP Query: Eligibility & Benefits → Member ID: ABC123 → Service: CPT 99213]
[MCP Result:
Plan Type: PPO
Deductible: $1,500 | Met: $900 | Remaining: $600
Copay (Primary Care Office Visit): $25
Coinsurance (if deductible applies): 20%
OOP Max: $6,000 | Met: $2,450 | Remaining: $3,550
Deductible Application: Copay applies first, deductible waived for PCP visits
]
Member Responsibility for 99213: $25 copay
[MCP Action: Document Coverage Note in Chart → "For 99213: $25 copay. Deductible waived for PCP visits. OOP remaining $3,550."]
[MCP Action (Optional): Display Patient Responsibility at Check-In]
If you’d like, I can:
- Generate a patient-friendly explanation
- Send this coverage information via SMS/email
- Or log this in your EMR notes automatically
Just reply:
Send explanation
or
Add to chart
[MCP Query: Active Insurance Benefits → Patient: "John Doe" → Service Type: Physical Therapy]
[MCP Result:
Plan: Cigna Open Access Plus
PT Authorization Requirement: YES
Visit Limit: 20 visits per calendar year
Auth Trigger: Authorization required starting at visit #1
Copay: $25 per visit
]
This plan does require prior authorization for PT services.Authorization must be obtained before the first visit.
[MCP Action: Create Authorization Request Packet → Attach last office note + PT referral]
[MCP Action: Route to Billing/Authorization Queue → Priority: Standard]
[MCP Action: Document note in chart → "PT requires prior auth. Auth request initiated."]
If you’d like, I can:
- Submit the authorization request now
- Generate a supporting clinical summary
- Or track visit counts automatically
Just reply:
Start the auth
or
Show visit usage
Claim Status and Details
CTRL ENTER interprets claim information you already have on screen—including billed amounts, allowed amounts, denials, and adjustment codes—and explains what happened, why, and what to do next.
Claim 0440ebb0-0252-4667-94e4-b49a2406b77f is currently in process with the payer.
Details
- Payer: Cigna Open Access Plus
- Date of Service: 2025-03-14
- CPT Codes: 99214 (office visit), 81003 (urinalysis)
- Submitted: 2025-03-17
- Status: Pending payer review
- No denial or payment posted yet
This status usually means the claim has passed electronic edits and is now waiting for the payer to finalize their determination. Most payers finalize claims within 7–21 business days.
Next Step
If the claim remains in pending status after 30 days, follow up with the payer or check the provider portal for updates.
Here is the information for claim ABC123:
Claim Summary
- Date of Service: 2025-01-19
- Payer: Horizon Choice PPO
- CPT Codes: 99214 (office visit), 36415 (venipuncture)
- Total Billed: $245.00
- Allowed: $168.00
- Paid: $0.00
- Status: Denied
Denial Details
- CARC Code: CO-50 – Non-covered services / Not medically necessary
- RARC Code: N386 – This decision was based on payer medical policy.
This means the payer determined the diagnosis submitted did not support medical necessity under their clinical criteria for the services billed.
Next Steps (Recommended)
- Review the visit documentation for symptoms, history, exam, and medical decision-making.
- Confirm whether a more accurate or specific diagnosis is supported in the documentation.
- If documentation supports medical necessity, submit a corrected claim or appeal with medical records.
- If visit was preventative or routine screening, verify that the correct preventive code set was used.
CTRL ENTER retrieves claim status directly from your billing system and payer portals, pulling line-level details, denial codes, remark codes, payment postings, and processing history. It then organizes the findings and generates recommended resolution steps automatically.
[MCP Query: Claims → Claim ID: 0440ebb0-0252-4667-94e4-b49a2406b77f]
[MCP Result:
Patient: Emily Carter (MRN 009217)
Payer: Cigna Open Access Plus
DOS: 2025-03-14
CPTs: 99214, 81003
Submitted: 2025-03-17
Status: Pending adjudication
Processing Stage: Payer review queue
Last Activity: 2025-03-21 — Accepted into payer system (277CA)
]
The claim is actively pending with the payer. No action required yet.
[MCP Action: Create Watch → Notify if status changes to Paid or Denied]
[MCP Action: Document Chart Note → "Claim 0440ebb0-0252-4667-94e4-b49a2406b77f: In payer review as of today."]
If you'd like, I can also:
- Auto-check status daily
- Contact payer via portal
- Prepare outreach script
Just reply:
Track it
or
Follow up now
[MCP Query: Claims → Claim ID: ABC123]
[MCP Result:
DOS: 2025-01-19
Payer: Horizon Choice PPO
CPTs: 99214, 36415
Billed: $245.00
Allowed: $168.00
Paid: $0.00
Denial: CO-50 (Not Medically Necessary)
RARC: N386 (Policy-based determination)
]
[MCP Query: EOB → Claim ID: ABC123]
[MCP Result:
Payment: $0.00
Adjustment Codes: PR-0, CO-50
Remark: Must meet clinical criteria / submit medical records for reconsideration
]
Root Cause Identified:Diagnosis code submitted did not align with the payer’s medical necessity criteria for 99214.
[MCP Action: Generate Appeal Packet →
Includes: Progress note, Problem list, Medication list, Assessment & plan summary
]
[MCP Action: Assign Task → Billers/Appeals Queue → Due in 3 business days]
[MCP Note Logged in Chart → "Claim ABC123 denied CO-50. Appeal packet started."]
If you'd like, I can:
- Draft the appeal letter
- Suggest alternative diagnosis codes supported by clinical documentation
- Auto-resubmit once reviewed
Just reply:
Prepare appeal
or
Suggest alternate DX
Patient Collections
CTRL ENTER helps you explain balances to patients clearly and accurately. It reviews the charges and payments shown on screen, breaks down what the patient owes, identifies why the balance exists, and suggests phrasing you can use during collection conversations.
From the ledger on screen for John Doe (MRN-12345) in 2025:
- 2025-01-19: $50.00 • Visa • Applied to INV-10081 (copay)
- 2025-03-07: $120.00 • ACH portal • Applied to INV-10177 (deductible)
- 2025-06-15: $35.00 • Cash • Applied to INV-10302 (coinsurance)
- 2025-09-28: $62.48 • Card on file • Applied to INV-10455 (patient resp)
Total patient payments YTD: $267.48
To record today’s copay:
- Open the patient’s account or visit for MRN-200232435.
- Select “Add Payment” or “Post Copay”.
- Enter $50.00, choose the payment method (cash, card, or check), and assign it to the current visit.
- Save and ensure the new balance and patient responsibility reflect correctly.
- If a receipt is needed, print or send electronically.
This ensures the copay is properly applied to today’s encounter and the patient’s balance remains accurate.
To allocate this payment, open your billing or payment posting screen, locate payment ID pay_src_001, and apply it to the claim <claim-id>.
Make sure to:
- Match the payment to the correct date of service.
- Apply the amount to the claim balance (not the patient balance, unless intended).
- Confirm the remaining balance and save.
This will ensure the payment is properly tied to the visit and updates both the claim balance and patient responsibility.
CTRL ENTER retrieves account balances, payment history, statements, and plan benefits directly from your system. It calculates patient responsibility, checks for payment plan eligibility, creates payment links, and documents collection attempts automatically to support consistent follow-through and reduced A/R.
[patients.lookup(name="John Doe", dob?=optional)] → mrn="MRN-12345"
[payments.list(mrn="MRN-12345", start="2025-01-01", end="2025-12-31")] → 4 items totaling $267.48
[payments.allocate_overview(mrn="MRN-12345", fy=2025)] → mapping to invoices INV-10081/10177/10302/10455
[reports.export(type="patient_payments", mrn="MRN-12345", period="2025YTD", format="csv")] → /exports/johndoe_2025YTD.csv
Answer: John Doe has made 4 payments totaling $267.48 in 2025 (1/19 $50.00, 3/07 $120.00, 6/15 $35.00, 9/28 $62.48).
Action: [reports.download("/exports/johndoe_2025YTD.csv")] (optional) or [statements.send_summary(mrn="MRN-12345")].
[MCP Query: Patient Account → MRN: 200232435]
[MCP Result: Patient Found → Adam Nguyen]
[MCP Action: Post Payment → Amount: $50.00 → Type: Copay → Method: Card (default) → Apply To: Today’s Visit]
[MCP Action: Update Ledger → Recalculate Patient Responsibility]
[MCP Action: Generate Receipt → Delivery: Email on file]
$50 copay has been recorded and applied to today’s encounter.
A receipt has been sent to the email associated with the patient account.
If you'd like, I can also:
- Add a quick note documenting copay collection in the chart
- Create or update a payment plan
- Send text confirmation to the patient
Just reply: Add note / Send text / Check for remaining balance
[MCP Result: Unapplied payment available → $50.00]
[MCP Action: Document Note in Ledger → "Payment pay_src_001 allocated to claim <claim-id>."]
- Send a receipt
- Check if additional balance remains
- Apply remaining funds automatically to oldest claims
Send receipt / Check remaining / Apply remaining
Documents and PDFs
CTRL ENTER helps you understand and work with documents already on your screen.It can read PDFs, scanned EOBs, faxes, and attachments you upload or reference, summarize what’s in them, and guide you on what actions to take next.
I can draft a CMS-1500 from what’s on your screen / what you upload. Here’s the filled summary (placeholders where I don’t see data):
- Patient (Box 2): John Smith — DOB: <DOB> — Sex: <M/F>
- Insurance (Box 1): <Plan Type> | (1a) Member ID: <Subscriber ID>
- Insured (Box 4/6/7/11): <Insured Name / Relationship / Address / Policy #>
- Accident/Illness (Box 10 a–c): No (unless documented otherwise)
- Dates (Box 14): Onset/Visit: 2024-07-24
- Diagnosis (Box 21): <DX1>, <DX2>, <DX3>, <DX4>
- Service line (Box 24 A–J):
- Date: 2024-07-24 | POS: <POS> | CPT: <99213 or other> | Mod: <…> | Units: 1 | Charges: <$$> | NPI: <Rendering NPI>
- Totals (Box 28–30): Total: <$> | Paid: <$> | Balance: <$>
- Billing (Box 25/31/32/33): Tax ID: <EIN> | Signature on file | Facility: <Name/Addr/NPI> | Billing: <Name/Addr/Phone/NPI>
What I still need to complete/export the form: subscriber ID, DX codes, CPT/POS/charges, rendering & billing NPI, and payer details. Share a screenshot/EOB or paste those fields and I’ll finalize the CMS-1500 text/PDF.
To retrieve the EOB for this payment:
- Open your EOB / Remittance section or payer portal.
- Look for Cigna payments posted on 2024-07-24.
- Identify the payment by the EFT/Check number or batch ID.
- Download or view the EOB PDF associated with that payment.
Once located, you can save or attach it to the patient’s claim record if needed.
If you provide the check number, EFT ID, or payment amount, I can help narrow it down further.
CTRL ENTER can locate, retrieve, and deliver documents automatically.It will find the claim or payment, fetch the associated PDF (EOB, CMS-1500, appeal packet, referral, etc.), and return a temporary secure download link, while also offering to attach or log the document in the patient or claim record.
[Patients.search name="John Smith" date_of_service="2024-07-24"]
→ Found: MRN 200113, DOB 1985-03-09
[Encounters.get mrn="200113" date="2024-07-24"]
→ Encounter #: ENC-77421, POS 11, Rendering NPI 1871567890
[Payers.primary mrn="200113" as_of="2024-07-24"]
→ Blue Shield PPO, Subscriber ID BS123456789, Insured: John Smith (self)
[Diagnoses.list encounter_id="ENC-77421"]
→ R53.83, M54.50
[Procedures.list encounter_id="ENC-77421"]
→ 99213 (1 unit), Charge $145.00, Modifiers none
[Providers.billing_profile facility="Downtown Multi-Specialty"]
→ Billing NPI 1235467890, EIN 12-3456789, Address 123 Clinic Way, San Diego, CA 92101, Phone (619) 555-0100
[Forms.create type="CMS1500" encounter_id="ENC-77421"]
[Forms.fill box="1" value="X PPO"]
[Forms.fill box="1a" value="BS123456789"]
[Forms.fill box="2" value="John Smith"]
[Forms.fill box="3" value="1985-03-09 M"]
[Forms.fill box="4" value="John Smith"]
[Forms.fill box="6" value="Self"]
[Forms.fill box="7" value="123 Palm Ave, San Diego, CA 92102"]
[Forms.fill box="10a/10b/10c" value="No/No/No"]
[Forms.fill box="11" value="BS-PPO"]
[Forms.fill box="12/13" value="Signature on file"]
[Forms.fill box="14" value="2024-07-24"]
[Forms.fill box="21" value="A: R53.83 B: M54.50"]
[Forms.fill box="24A-J" value="DOS: 2024-07-24 | POS: 11 | CPT: 99213 | Units: 1 | Charge: $145.00 | NPI: 1871567890"]
[Forms.fill box="25" value="12-3456789"]
[Forms.fill box="27" value="Accept assignment: Yes"]
[Forms.fill box="28/29/30" value="$145.00 / $0.00 / $145.00"]
[Forms.fill box="31" value="Signature on file | 2024-07-24"]
[Forms.fill box="32" value="Downtown Multi-Specialty, 123 Clinic Way, San Diego, CA 92101 | NPI 1235467890"]
[Forms.fill box="33" value="Downtown Multi-Specialty Billing, 123 Clinic Way, San Diego, CA 92101 | Phone (619) 555-0100 | NPI 1235467890"]
[Documents.render form_id="CMS1500-ENC-77421" format="pdf"]
→ CMS-1500 generated: cms1500_JohnSmith_2024-07-24.pdf
Quick checks run: subscriber ID present ✅, POS 11 valid for 99213 ✅, assignment accepted ✅, diagnosis pointers mapped A→line 1 ✅, secondary insurance not detected ✅.
Warnings: None.
If you want, I can also add a secondary line (e.g., nurse visit or labs) — just say “add line 2 with <CPT/modifiers/charge>.”
[MCP Query: Payments → Payer: Cigna → Payment Date: 2024-07-24]
[MCP Result:
Payment Found
EFT #: 98177245
Total Paid: $3,422.18
Batch ID: PAY-CIG-072424
]
[MCP Action: Retrieve EOB PDF → Source: Cigna Remittance → Batch: PAY-CIG-072424]
[MCP Result: File Retrieved → eob_Cigna_2024-07-24.pdf]
[MCP Action: Attach EOB to Claim Records → Claims associated with batch]
[MCP Action: Save Copy to Patient Documents (if applicable)]
EOB PDF is now ready.
Would you like me to:
- Download it
- Send via secure message
- Attach to a specific claim
- Open it on screen
Just reply:
Download / Attach / Open
Chargemaster and Estimation
CTRL ENTER interprets procedure and service pricing you already have on screen and explains how the patient’s cost is calculated based on deductible, copay, and coinsurance. It walks through the math step-by-step so you can confidently explain costs.
The contract and chargemaster that apply to today’s date of service depend on:
- The patient’s active insurance plan at the time of service
- Whether the provider and facility are in-network with that payer
- The place of service (office, outpatient hospital, ASC, telehealth)
- Any plan-specific fee schedules or negotiated rates
To determine the correct pricing:
- Confirm which payer is primary as of today.
- Check if the rendering provider/facility is in-network.
- Use the corresponding fee schedule or chargemaster associated with that payer + specialty + POS.
- If multiple schedules could apply, default to the plan-specific contracted rate.
If you tell me the payer and place of service, I can identify the correct chargemaster manually.
Estimate: $25 patient responsibility
Assumptions (dummy data for training):
- Plan: In-network PPO
- CPT 99213 office visit has $25 copay, deductible waived, 0% coinsurance for E/M office visits
- Contracted (allowed) amount: $115.00
- Deductible: $1,500 (met $900; remaining $600) — waived for 99213 per plan rule
- OOP max: $4,000 (met $1,700; remaining $2,300)
Math:
- Allowed: $115.00
- Apply copay (deductible waived): $25.00 patient
- Insurer pays: $115.00 − $25.00 = $90.00
Notes: If ancillary services (labs, injections, procedures) were performed, those are separate and may apply to deductible/coinsurance.
CTRL ENTER automatically finds the correct chargemaster item(s), pulls real-time eligibility and benefits, and performs the full cost-estimate calculation for you.It combines allowed amounts, accumulators, and visit limits, shows the math, and can record the estimate directly in the chart or send it to the patient.
[MCP Query: Patient Coverage → as_of: today]
[MCP Result: Primary Payer = Cigna PPO]
[MCP Query: Provider Network Status → Provider: <NPI> → Payer: Cigna PPO]
[MCP Result: In-Network (Contract Group: CIG-PPO-WEST-2025)]
[MCP Query: Chargemaster / Fee Schedule → Contract Group: CIG-PPO-WEST-2025 → Place of Service: 11]
[MCP Result: Chargemaster: CIG-PPO-WEST-2025-OP-OFFICE]
Answer:Today’s DOS is governed by the CIG-PPO-WEST-2025 contract and corresponding outpatient office chargemaster schedule.
[MCP Action: Attach Contract Snapshot to Encounter]
[MCP Action: Display Allowed Amounts for Today’s CPTs]
If you'd like, I can now:
- Show the allowed amounts for specific CPTs
- Generate a patient cost estimate (with the math shown)
- Check if prior authorization impacts pricing
Just reply:
Show allowed amounts / Estimate patient cost
[Eligibility.check(member_id=“ABC123”, dos=today, cpt=“99213”)] → returns: in-network, copay $25, deductible waived for 99213, coinsurance 0%
[Accumulator.get(member_id=“ABC123”)] → deductible: $1,500 (met $900), OOP max: $4,000 (met $1,700)
[ContractRate.lookup(payer=“PPO-Example”, cpt=“99213”, pos=“11”)] → allowed $115.00
[Estimator.calculate(inputs={allowed:115, copay:25, deductible_applies:false, coinsurance:0})] → patient $25.00, plan $90.00
[Ledger.previewPost(member_id=“ABC123”, dos=today, cpt=“99213”, patient_resp=25.00)] → ready
Caveat: If [ContractRate.lookup] returns a different allowed amount or [Eligibility.check] shows that the copay doesn’t waive the deductible for this plan, the estimator will re-run and adjust (e.g., deductible-first or coinsurance).
Messaging and Support Tickets
CTRL ENTER helps you understand and respond to messages or ticket notes already visible on your screen.It summarizes the conversation, identifies next steps, and suggests wording for replies.
Sure — here’s a draft message you can send to your support team regarding this claim:
Subject: Assistance Needed – Claim <id>
Hello,
I’m reaching out regarding claim <id>. We need support reviewing its status and determining any next steps.
Please let me know what additional information is needed.
Thank you.
You can copy/paste this into your existing support email or ticketing system.
I looked for unread provider messages tied to you and surfaced the latest items so you can triage quickly.
Unread (5)
- msg_2025_1107_001 — From: Dr. Patel — Subject: Missing op notes for 09/10 claim — Linked: MRN-12345, Claim ABC123 — Received: 2025-11-07 09:12
- msg_2025_1106_014 — From: Front Desk — Subject: Copay discrepancy (PT visit) — Linked: MRN-200232435 — Received: 2025-11-06 16:41
- msg_2025_1106_009 — From: Coder Team — Subject: 99213 vs 99214 justification — Linked: John Doe (MRN-445566) — Received: 2025-11-06 11:03
- msg_2025_1105_021 — From: Billing QA — Subject: Need EOB PDF (Cigna 2024-07-24) — Linked: Payment CIG-2024-07-24 — Received: 2025-11-05 15:27
- msg_2025_1105_017 — From: Auths — Subject: PT prior auth expiring — Linked: Jane Smith (DOB 02/14/1989) — Received: 2025-11-05 10:02
Quick next steps (recommendations):
- Reply to #1 with the op notes or assign to Coder Team.
- Attach the EOB PDF to #4.
- Confirm PT auth status in #5 and update the schedule.
CTRL ENTER can create, update, and organize internal message threads and support tickets automatically.
It can start new threads, add comments, link messages to specific claims or patients, and surface past communication history so nothing is missed.
Okay — I’ll create the support message and link it to the correct claim record.
Steps:
- [MCP: Fetch Claim] Retrieve claim
<id>details. - [MCP: Create Message Thread] Open a new support message associated with the claim.
- [MCP: Post Message Body] Add your note.
- [MCP: Record Link] Ensure the message is visible in the claim’s activity timeline.
Message created:
“We need assistance reviewing claim <id>. Please verify status and next recommended action. Let us know if any additional documentation is needed.”
You’ll see the thread appear in the Claim → Activity → Messages panel in a few seconds.
[MCP.messages.list assignee=me, status=unread, include=patient,claim,attachments, limit=50]
[MCP.patients.get ids=[MRN-12345, MRN-200232435, MRN-445566]]
[MCP.claims.get ids=[ABC123]]
Unread (5)
- msg_2025_1107_001 | From: Dr. Patel | Missing op notes for 09/10 claim
Patient: MRN-12345 (Jane Smith) | Claim: ABC123 | Received: 2025-11-07 09:12 | Priority: High
Attachments: none - msg_2025_1106_014 | From: Front Desk | Copay discrepancy (PT visit)
Patient: MRN-200232435 | Visit: 2025-11-05 | Received: 2025-11-06 16:41 | Priority: Normal - msg_2025_1106_009 | From: Coder Team | 99213 vs 99214 justification
Patient: John Doe (MRN-445566) | DOS: 2025-11-04 | Received: 2025-11-06 11:03 | Priority: Normal - msg_2025_1105_021 | From: Billing QA | Need EOB PDF (Cigna 2024-07-24)
Payment: CIG-2024-07-24 | Received: 2025-11-05 15:27 | Priority: Normal
[MCP.documents.find type=EOB, payer=Cigna, posted_date=2024-07-24] - msg_2025_1105_017 | From: Auths | PT prior auth expiring
Patient: Jane Smith (MRN-12345, DOB 02/14/1989) | Received: 2025-11-05 10:02 | Priority: High
[MCP.eligibility.check_auth service=PT, payer=current, patient=MRN-12345]
One-click actions
- Mark a set as read: [MCP.messages.mark_read ids=
["msg_2025_1107_001","msg_2025_1106_014"]] - Assign #1 to Coding: [MCP.messages.assign id=
msg_2025_1107_001, team=Coding] - Reply with attachment on #4:
[MCP.documents.get doc=EOB:CIG-2024-07-24] →
[MCP.messages.reply id=msg_2025_1105_021, text=Attached the Cigna EOB for 2024-07-24. Let me know if you also need the remit summary., attachments=[doc_id]]
Create and Edit Professional Claims
CTRL ENTER guides you through reviewing or editing a claim that’s already in front of you.It helps confirm codes, diagnoses, modifiers, place of service, units, and billed amounts, and advises on corrections or resubmissions.
To update the primary payer on claim ABC123:
- Open the claim details screen for claim ABC123.
- Locate the Insurance / Payer section.
- Change the primary payer to Cigna and verify the subscriber ID, group number, and plan type are correct.
- Confirm whether the patient’s coordination of benefits (COB) or coverage order needs updating in their chart.
- Save the changes, then resubmit the claim if it has not yet processed.
This ensures the claim is routed to the correct payer for adjudication.
To create the claim from the CMS-1500 you provided:
- Review the form fields on the CMS-1500:
- Patient information (Boxes 2–8)
- Insurance/Subscriber details (Boxes 1, 1a, 4, 11)
- Diagnosis codes (Box 21)
- Service lines with CPT, modifiers, units, and charges (Box 24)
- Rendering/Billing provider details (Boxes 31–33)
- Enter this information into your claim entry screen in your billing system.
- Double-check:
- Diagnosis pointers match the correct service lines.
- Place of Service is accurate.
- Billing NPI and Rendering NPI are correct.
- Save and submit the claim once the information matches the CMS-1500 exactly.
Let me know if you want me to read the CMS-1500 for you and summarize the key values.
CTRL ENTER retrieves the latest claim payload, prepares the corrected or new claim, and walks you through confirming it before submission. It can edit line items, attach supporting documentation, validate coding rules, and submit or resubmit the claim once you approve.
[MCP Query: Claim → claim_id: ABC123]
[MCP Result: Current Primary Payer = UnitedHealthcare PPO]
[MCP Query: Patient Coverage → Identify Active Cigna Policy]
[MCP Result: Cigna PPO (Subscriber ID: CIG-88274110) — Effective as of 2024-01-01]
[MCP Action: Update Claim → Set Primary Payer = Cigna → Apply Subscriber ID + Group Number]
[MCP Action: Update Coordination of Benefits in Patient Record → Primary: Cigna → Secondary: UnitedHealthcare]
[MCP Action: Resubmit Claim → claim_id: ABC123 → Send to Cigna Clearinghouse Route]
Primary payer successfully updated and claim has been resubmitted to Cigna.
A COB update note has been added to the patient account for record accuracy.
If you'd like, I can also:
- Verify eligibility for the Cigna policy
- Check claim status after resubmission
- Notify billing team with an internal message
Just reply:
Verify eligibility / Track status / Notify billing
[MCP Action: Read Document → Type: CMS-1500 → Source: Attached PDF]
[MCP Result: Form parsed successfully]
[MCP Extracted Data:
Patient: <Name> (MRN/ID matched)
Payer: <Primary Insurance Name> (Subscriber ID detected)
DOS: <Date>
CPT Lines: <CPT / Modifiers / Units / Charges>
Diagnosis Codes: <DX1, DX2, DX3, …>
Rendering NPI: <NPI>
Billing NPI / TIN: <NPI / EIN>
]
[MCP Action: Create Claim Record → Populate fields using extracted CMS-1500 data]
[MCP Action: Validate Coding & COB]
[MCP Action: Save Claim → Claim ID Assigned]
[MCP Action (Optional): Submit Claim via Clearinghouse → pending your confirmation]
Claim has been created from the CMS-1500.Tell me “Submit” if you’re ready to send it to the payer.
ENTER is HIPAA compliant and SOC 2 Type 2 certified. See our trust center to learn more.