Medical Billing Software FAQ for Billing Companies

Short answer

This FAQ answers the decision questions a billing company asks before buying software: what it is, what it costs, how it compares, and what to check before signing. For term definitions (CARC, RARC, PLB, COB, and the rest of the X12 and EDI vocabulary), see the medical billing glossary instead of re-reading them here. Medi is medical billing software built around billing-company operations across multiple client practices, priced per claim submitted. It routes 837/835/270/271/276/277/278 transactions through Stedi as its clearinghouse. It is not an EHR or a clearinghouse on its own.

Billing-company software FAQ

What is medical billing software for billing companies?

Software built around teams that run revenue cycle work for many client practices at once. The buyer is the billing company, not the practice. Evaluate it on five things: tenancy model (billing company versus practice as primary), pricing structure (per-practice versus per-provider), cross-practice work queues, permissioning for mixed staff, and migration tooling. See the billing-company software evaluation guide for the full framework.

What is Medi?

A billing-company-first revenue cycle platform. Priced at $1.00 per claim, with no monthly fee, no per-practice fee, and no per-provider fee; the rate steps down to $0.90 and $0.80 at published volume tiers. Adding providers or client practices does not change the rate. Usage add-ons such as eligibility and claim status are priced per transaction. Uses Stedi as the clearinghouse for 837 claim submission, 835 ERA, 270/271 eligibility, 276/277 claim status, 278 authorization, and 277CA acknowledgments. Includes denial workflows, ERA posting, A/R reporting, payment workflows, and migration tooling. Does not include an EHR, scheduling, charting, or patient engagement modules.

Is Medi a clearinghouse?

No. Medi is the billing-company operating layer on top of Stedi, its clearinghouse. The clearinghouse moves the EDI transactions; billing-company software owns the daily work queues, reporting, access controls, and follow-up decisions on top of them.

What is the difference between a clearinghouse and billing-company software?

A clearinghouse moves the EDI traffic: 837 claims out, 835 ERAs back, 270/271 eligibility checks, 276/277 status, 278 authorizations. Examples include Stedi, Office Ally, Availity, Claim.MD, and Waystar. Billing-company software is the operating layer: who owns each claim, what needs review, which practice is affected, what was posted, and what follow-up is still open. Some products do both, but most are stronger at one than the other.

How is billing-company software different from practice-management software?

Practice-management software treats the practice as the tenant. Billing-company software treats the billing company as the tenant. The difference shows up in user switching, permissions, cross-practice queues, pricing structure, and what duplicates when you add the eleventh client. See multi-practice billing-company operations for the full architectural breakdown.

Pricing and contracts

How much does Medi cost?

$1.00 per claim, flat regardless of service-line count, with ERA posting included at no separate fee, and $0.90 and $0.80 rates for the volume above each published tier mark. No monthly fee. No per-practice fee. No per-provider fee. No contract required. Eligibility (270/271) is $0.25 per inquiry. Claim status (276/277) is $0.20 per inquiry. COB, insurance discovery, or claim attachment is $1.50 each (turned on book by book during onboarding). 277CA acknowledgments and claim PDFs are included. See the pricing page for the full table and example monthly estimates.

How does Medi pricing compare to Tebra or AdvancedMD?

Tebra and AdvancedMD price around provider count, bundle, and specialty. Tebra publishes per-provider rates at tebra.com/pricing/overview; its billing-comparable tier (Billing Starter) runs $99 to $199 per provider, but only under 100 claims a month, with full EHR bundles reaching $399 to $799 once a practice runs above that for three straight months. AdvancedMD publishes its rate card at advancedmd.com/software-pricing; its PM + Medical Billing tier (the Medi-comparable tier) is $429 per provider, with EHR bundles reaching $729 to $999. Medi charges per claim, not per provider and not per practice, so adding a provider or a client practice never changes the rate. The gap widens as provider count grows, because each new provider a client hires raises the Tebra or AdvancedMD bill while Medi's cost tracks claim volume instead. See the Medi vs Tebra comparison for a detailed breakdown.

Is there a setup or onboarding fee?

No separate per-provider onboarding fee. Medi runs an implementation review before production access, included in the claim rate.

EDI and clearinghouse

Which EDI transactions does Medi handle, and which does it not?

Medi routes 837 (claims), 835 (ERA), 270/271 (eligibility), 276/277 (claim status), 278 (authorization), and 277CA (acknowledgment) through Stedi, its clearinghouse. A billing company does not need a separate clearinghouse contract or a second login to check acknowledgment or remittance status. See the medical billing glossary for what each transaction carries, and the 277CA acknowledgment guide for how rejections are distinct from denials.

ERA and payment posting

How does Medi handle ERA posting?

Medi auto-posts clean matches from the 835 and holds exception lines for review: write-off variance over tolerance, secondary not posted, recoupment, or a PLB (provider-level) adjustment. Every posting decision, automatic or manual, keeps an audit trail back to the source ERA. See the ERA posting guide for the full workflow, and the glossary for what PLB and recoupment mean.

Denials and appeals

How does Medi help a biller work a CARC/RARC-coded denial?

Denied lines carry their CARC and RARC codes into the work queue, grouped by the two-letter responsibility code (CO, PR, OA, PI) so a biller can tell at a glance whether a line needs an appeal, a contractual write-off, or a patient bill. See the denial management workflow guide for the common codes and triage pattern, and the glossary for what each code category means.

How fast should denials be worked?

Industry practice is 7 to 14 days for high-dollar or time-sensitive denials, 30 days for lower-priority. The constraint is appeal deadline: Medicare gives 120 days for redetermination, most commercial payers give 60 to 180 days from the date of denial, Medicaid varies by state. See the denial management workflow guide for the full triage pattern.

How do I know if my denial rate is a problem?

Compare it against the MGMA and Experian benchmarks in the glossary's A/R and performance metrics table. A rate meaningfully above the industry average is worth investigating for a coding, eligibility, or payer-enrollment root cause rather than working denials one at a time.

COB and eligibility

Does Medi handle COB and insurance discovery, or do I need a separate tool?

Both run inside Medi. Coordination of benefits determines payer order when a patient has more than one coverage; insurance discovery finds active coverage for a patient who does not present a card. Insurance discovery is priced per query and is rolling out now, enabled for your book at onboarding. See the eligibility, COB, and insurance discovery guide for the workflow, and the glossary for the terms.

Underpayment and contracts

How does Medi detect underpayments?

Medi compares the 835 paid amount against the expected amount from the payer contract and fee schedule, and flags the variance for human review rather than treating it as automatically recoverable: is the right contract loaded, is a secondary payment still outstanding, is it a legitimate carve-out. See the underpayment detection guide for the full workflow.

How big is the underpayment problem industry-wide?

Estimates vary, but MGMA and industry analyses commonly cite underpayments and contract leakage in the range of 1 to 5 percent of net revenue for typical practices, with higher percentages in specialties with complex fee schedules. The recoverable portion depends on accurate contract loading and effective contracting workflows.

AI and automation

Can AI handle medical billing without human review?

No. AI can support billing teams on specific tasks (prioritization, drafting, summarization, anomaly detection) but cannot replace human judgment on payer rules, compliance, exception handling, patient responsibility, appeals, and client relationships. See the AI medical billing reality guide for the full framing and HIPAA boundary.

Is it a HIPAA violation to use ChatGPT for billing work?

Yes, if PHI is involved. Consumer ChatGPT, Claude.ai consumer, and Gemini consumer do not sign Business Associate Agreements and cannot receive PHI without creating a reportable breach. The compliant equivalent is the same vendor's enterprise API with a signed BAA, or a model hosted inside a BAA-covered cloud platform.

Migration

How long does a typical RCM platform migration take?

For Medi cutover planning, use around one business day per client practice once exports and payer-enrollment inputs are ready. Payer enrollment and legacy A/R closeout run in parallel, and multi-client billing companies still move practices in waves rather than all at once. The risk is an unmanaged cutover, not a fast one: aged claims, payer enrollment, and custom rules need named owners before go-live.

Does Medi charge a migration fee?

Migration is free with a 12-month commitment. Month-to-month customers pay $100 per practice as a one-time migration fee, capped at $3,000 total regardless of practice count. Data export is always free and is not tied to contract terms or payment status. No early-termination fee applies under either path. See the pricing page for the full schedule.

What is a legacy A/R closeout?

The arrangement where the outgoing vendor continues working claims with dates of service before cutover for 60 to 90 days after migration, while the new vendor works claims with dates of service from cutover forward. Protects trailing revenue during the transition. Should be contractually required in the outgoing vendor agreement before signing with a new platform.

What does not migrate cleanly between billing platforms?

Open-claim follow-up notes, in-flight appeals, unposted ERAs sitting in queues, payer enrollment ties, and the mid-investigation state of denials someone was working at cutover. Patient demographics, claim history, ledger balances, and clinical chart bundles typically do migrate. See the Tebra migration guide for the practical inventory.

How current is this FAQ?

Last reviewed 2026-07-27. X12 code references are from x12.org/codes. CMS guidance is from cms.gov electronic billing. HIPAA guidance is from HHS HIPAA for Professionals. Industry statistics are from the MGMA and Experian sources cited inline. Vendor pricing references were checked against Tebra's published pricing at tebra.com/pricing/overview and AdvancedMD's published pricing at advancedmd.com/software-pricing.