Learn the data model

Anatomy of a workers' comp bill

A MindBill bill is a frozen claim snapshot plus an explicit payer packet. It contains the information needed to render a CMS-1500 and transmit its electronic equivalent.

One immutable business snapshot

Create the bill with the values that should print on that claim: patient, injury, claims administrator, provider, location, diagnoses, and service lines. You may reference your own records with externalId, but you do not need to synchronize a provider or location database into MindBill.

What goes on the bill

GroupExamplesWhy it matters

PatientName, date of birth, addressIdentifies the injured worker

ClaimClaim number, employer, date of injury, claims administratorIdentifies the workers' comp case and destination

ServiceDate of service, diagnoses, procedure codes, modifiers, unitsDescribes what is being billed

Billing providerLegal name, TIN, billing NPI, phone, remittance addressIdentifies the payee and tax entity

Rendering providerClinician, NPI, taxonomy, license, QME or AME roleIdentifies who performed the service

Service locationFacility address and place-of-service codeIdentifies where the service occurred

CMS-1500 and 837P are two views of the same claim

The CMS-1500 is the familiar paper form. The 837P is the X12 electronic transaction used to send professional claims. It is a hierarchical EDI document with loops, segments, qualifiers, control numbers, and implementation-guide constraints.

Developer inputTyped JSONclaim.claimNumberserviceLines[0].code

→

Human viewCMS-1500Box 11b / 11cBox 24D

Electronic view837P2300 / 2010BB2400 SV1

MindBill performs that translation and validates the destination requirements. Your integration stays on the typed bill resource.

The payer packet is explicit

Send documents together with the bill at submission. After submission, document resources identify the frozen payer packet. For a California medical-legal claim, a typical packet may include the final report, proof of service, W-9, letter of attestation, Form 122, or another required form.