> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Step 10: Submit your first claim
> Turn a real patient visit into an 837 claim: eligibility, documentation, coding, scrubbing, submission, and the acknowledgments that come back.
A **claim** is a structured request for payment sent from your professional entity to a payer, describing who was seen, by whom, for what, and under what diagnosis. Electronically it is an **X12 837** transaction. This step walks one visit all the way from the schedule to an accepted claim.
## What Meridian did
Mrs. Chen, 54, booked a full-body skin exam. The front desk verified eligibility two days before the visit and again at check-in. Dr. Shah saw her, documented the exam, and a suspicious lesion was biopsied. The biller entered charges the same afternoon, the scrubber flagged a missing modifier, the biller fixed it, and the claim went out that evening. A 999 came back in minutes and a 277CA the next morning, both clean.
## The seven stages of one claim
Before the visit, your system sends a **270** eligibility inquiry and the payer returns a **271** response: is coverage active on the date of service, what plan, what deductible remains, what copay, is prior authorization required.
Do this twice, at scheduling and at check-in. Coverage lapses between the two more often than you'd expect, and eligibility failures are the single largest denial category in most practices. **Save the 271 response.** It is your evidence in an appeal. See [Verify eligibility and benefits](/guides/billing/verify-eligibility).
Copay, and any known deductible or coinsurance. Money collected before the patient leaves is money you don't chase for 90 days. See [Deductibles, copays, coinsurance, and patient balances](/concepts/payments/patient-responsibility).
The clinician documents in the EHR. This is clinical work and it belongs entirely to the PC — the MSO provides the system, not the content.
Documentation is also the substrate for everything downstream: the code must be supported by the note, and in an audit the note is the only thing that matters. See [Billing compliance: the lines you never cross](/concepts/compliance/billing-compliance-basics).
Two code sets, doing two different jobs:
* **CPT** (or **CDT** in dentistry, plus **HCPCS Level II** for supplies and drugs), *what you did*
* **ICD-10-CM**, *why you did it*
Plus **modifiers** where a service needs qualification, and a **place of service** code. For Mrs. Chen's visit: an office visit E/M code, a biopsy procedure code, an ICD-10 code for the lesion, and modifier 25 on the E/M to indicate a significant, separately identifiable service on the same day as a procedure.
At launch, trust your clinician or a certified coder for the code selection itself. What *you* need to know is that codes must be supported by documentation and that assigning them is the PC's responsibility, not the MSO's. See [Clinical and billing code sets overview](/reference/edi/code-sets-overview).
The biller enters the charges. The **scrubber**, in the EHR, the clearinghouse, or both, checks the claim against payer-specific edits before it goes out: valid code combinations, required modifiers, NPI and taxonomy alignment, POS validity, authorization number present where required.
Scrubber rejections are free. Payer denials cost you 30 to 60 days. Fix everything the scrubber flags. See [Submit clean claims](/guides/billing/submit-clean-claims).
Your system generates the **837P** (professional) transaction and sends it to your clearinghouse, which validates, translates as needed, and routes it to the payer.
What's inside, in brief: the **billing provider** (your PC, Type 2 NPI, EIN, address), the **rendering provider** (Dr. Shah, Type 1 NPI), the **subscriber and patient**, the **claim** (total charge, place of service, diagnosis codes), and **service lines** (one per procedure, each with its own CPT, modifiers, charge, units, and pointers to the diagnoses that justify it).
See [The 837: how claims are told to payers](/concepts/payments/understanding-837s) and [837 file anatomy](/reference/edi/837-anatomy).
Two come back, and they are not the same thing.
| Acknowledgment | From | Means |
| -------------- | --------------------- | --------------------------------------------------------------------------------------- |
| **TA1** | Interchange level | The file envelope itself was or wasn't readable |
| **999** | Clearinghouse / payer | The file was syntactically valid X12 (or wasn't) |
| **277CA** | Payer | The payer **accepted the claim into adjudication** (or rejected it before adjudication) |
A **277CA rejection is not a denial.** The claim never entered adjudication, no determination was made, and, critically, it usually does not stop the timely filing clock. Fix and resubmit the same day. See [X12 transaction sets](/reference/edi/x12-transaction-sets).
## Rejection vs denial, learn this now
This distinction confuses new billers for months, and getting it wrong wastes appeals on claims that were never adjudicated.
| | Rejection | Denial |
| ----------------- | ----------------------------------- | ------------------------------------------------ |
| **Where** | Clearinghouse or payer front end | Payer adjudication |
| **Signalled by** | 999 or 277CA | 835 with a \$0 or reduced payment and CARC codes |
| **Meaning** | The claim was never accepted | The claim was processed and payment was refused |
| **Fix** | Correct and resubmit as a new claim | Corrected claim, or a formal appeal |
| **Appeal rights** | None, there's nothing to appeal | Yes, with deadlines |
See [Claim denials, explained](/concepts/payments/claim-denials).
## The eight things that reject first claims
New groups reject on the same short list, and almost all of it is enrollment data rather than clinical content:
1. **Billing provider NPI not recognized**, EDI enrollment isn't complete for that payer
2. **Legal name mismatch** between the W-9, the EIN letter, NPPES, and the claim
3. **Taxonomy mismatch** between what's on the claim and what you enrolled with
4. **Rendering provider not credentialed** or not linked to the group contract
5. **Service date before the provider's effective date**
6. **Subscriber ID wrong**, transposed digits, or the member ID without the alpha prefix
7. **Missing prior authorization number** on a service that required one
8. **Invalid place of service**, especially the telehealth codes 02 and 10, which mean different things
Note that six of the eight trace back to Steps 6 and 8. First-claim problems are usually enrollment problems.
🦷 **Dental**, you'll be sending **837D** with CDT codes, and dental payers have their own quirks: annual maximums, missing-tooth clauses, and frequency limitations that read like denials but are benefit design.
## Test before you go live
Ask your clearinghouse whether the payer supports a test submission, and send one claim before you send a hundred. A single test claim that comes back accepted validates your entire enrollment chain — EDI, NPI, taxonomy, name, and effective date — for the cost of one visit.
## Your artifact from this step
* One claim accepted at 277CA
* A documented rejection-resolution loop your biller can repeat
* Confirmed EDI connectivity to payer #1
* A saved 271 eligibility response attached to the encounter
## Checklist
* [ ] Eligibility verified and the 271 response saved
* [ ] Copay collected at the point of care
* [ ] Encounter documented before charges entered
* [ ] Codes assigned by the clinician or a certified coder
* [ ] Scrubber run and all edits cleared
* [ ] 837 submitted
* [ ] 999 received and clean
* [ ] 277CA received and shows accepted
* [ ] Any rejection corrected and resubmitted the same day
## Next
The remittance arrives and the money lands.
## Related topics
- [Submit clean claims](/guides/billing/submit-clean-claims.md)
- [Verify eligibility and benefits](/guides/billing/verify-eligibility.md)
- [Get prior authorizations](/guides/billing/get-prior-authorizations.md)
- [The life of a claim](/concepts/payments/claim-lifecycle.md)
- [The 837: how claims are told to payers](/concepts/payments/understanding-837s.md)
- [EDI and X12, gently](/concepts/payments/edi-and-x12-basics.md)
- [837 file anatomy](/reference/edi/837-anatomy.md)
- [Place of service codes](/reference/edi/place-of-service-codes.md)
- [Clinical & billing code sets overview](/reference/edi/code-sets-overview.md)