In development · claim files built, submission at the seam
The claim is checked before it leaves, not after it comes back.
A rejected claim costs a month and arrives looking like your mistake. Pexido establishes the coverage before anybody is seen, refuses to build a claim that would be rejected for something it can see, carries it to the payer, and reads the answer back onto the exact session it belongs to. Two things it will not do: take a contract with an insurer, or let insurance money pass through us.
Insurance
The mistake is caught before the claim leaves — and then the claim leaves.
Said in that order on purpose, because a claim that leaves wrong costs you a month. Pexido checks the coverage, builds the claim, carries it to the payer through a clearinghouse, and reads the answer back onto the right session. Two things it does not do, and will not: Pexido is not contracted with any insurance company, and insurance money never passes through us — the payer pays you directly, into your own account, under your own licence.
Nobody is seen on an insurance appointment until their coverage has been established
Pexido can ask the payer electronically whether somebody is covered, and the answer is recorded. Where the electronic answer is incomplete — and it often is — the telephone call your practice would have made anyway is recorded too: who asked, what they were told, the deductible, the copay, the coinsurance. No deposit and no payment is taken on an insurance appointment until that is done and the client has accepted what they were shown, with the exact wording frozen as they saw it. An unchecked plan also doesn't hold an hour on your calendar.
Four answers, because three of them aren't "no"
Covered. Couldn't say. Not covered. And handled by another company — a behavioural-health carve-out, which is deliberately its own answer because the client's next step is a different phone number rather than a closed door. The client's share can be recorded as genuinely unknown, and unknown is treated as a first-class answer rather than an error. We don't report a figure we would be guessing at: a plan's $3,000 deductible shown as "remaining" to somebody who has already met $2,900 of it is a number displayed with confidence and wrong.
The claim file, built from your own records
A standard 837P, assembled from the practice's records rather than retyped. The session's own identifier goes inside it, so any answer that comes back months later lands on a specific hour.
An almost-right claim is never written
Checked before the file is built, and if something would get it rejected the file is not produced — you get the problem in plain language with the place to fix it. A nearly-correct claim is rejected a day later anyway, and by then it looks like your mistake. This is rule-based: it tells you a required field is empty or no diagnosis was active, not whether your writing documents the code well enough. That judgement is yours and we would be guessing.
No member ID, no file
Incomplete patient information is one of the most common reasons claims come back, so it is caught at the source instead of after a rejection.
When the client isn't the policyholder
A child on a parent's plan is most of the caseload for anybody who sees young people, and it is exactly where claims break elsewhere. The subscriber is asked for by full name, written as a separate party with the correct relationship code, and the file isn't built without them.
The payer's answer, read and attached
Upload the remittance file and it is matched to the session by the identifier we put in the claim — not guessed from a date, a name and an amount. Billed, paid, contractual adjustment, and the client's own share split into deductible, coinsurance and copay. You see it before it is posted, and a posting is voided with a reason rather than edited away.
Authorisations that don't run out mid-treatment
An authorisation is held with its start date, its end date and its number of sessions, and the sessions used against it are counted — so the twelfth approved visit doesn't arrive as a surprise.
Double-billing a session takes a deliberate act
A session already sent in an earlier file isn't written into a second one unless you say that is what you meant.
Superbills, monthly reports, good faith estimates
For clients claiming out of network themselves, and for the forms you file. Each one carries the same standing sentence: Pexido is not contracted with any insurer and does not submit the claim. The estimate a client was given is kept exactly as they received it.
Panels, licences and exclusion lists
Staged reminders before a credential expires, the progress of a panel application, a warning when an insurance appointment is booked with somebody whose panel you don't hold, and a monthly screen against the federal exclusion lists.
Pexido does not choose the code
The code comes from the service you defined. The suggestion is based on session length and whether the client is new or established, and it says so — because the claim goes out under your licence, not ours.
Three honest limits. Enrolment is per payer and per provider, and for the payment file it is always required — routing it here cancels it wherever it arrives now, so that is a decision your practice makes deliberately, payer by payer, and nothing here makes it for you. Downloading the file and filing it yourself stays available and is not going away. And the 60-to-120-day wait to join a panel is the payer's, not ours — no software solves that one, and anybody who says otherwise is selling you something.
Keep reading
The rest of the therapist side.
A first group of therapists is being invited now.
Early profiles are free, and the people in that first group help shape what gets built next. Send your name, your state and your specialty — or just ask to be told when it opens, and we will leave it there.
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