Why didn't this claim get paid?

ClaimFix reads the rejected claim data your clearinghouse already sends back (837, 835, 277, 999) and answers with the specific reason and the specific field to fix.

What it does

A rejection answer is usually buried in payer codes, adjustment codes, and claim state spread across several X12 transactions. ClaimFix joins them and states the result in plain language: the dollar amount unpaid, the reason, the field, the wrong value, the corrected value, and whether the rendering NPI and procedure coding check out.

Example answer

$1,842 unpaid. Rejected because the subscriber ID on the submitted claim does not match the eligibility record. Fix: change the subscriber ID from ABC1234 to ABC12345. Rendering NPI and procedure coding appear valid. Confidence: high. Resubmission type: corrected claim.

The five tools

analyze_claim: what is in this claim and what state is it in.
analyze_rejection: why it was rejected, tied to the payer's codes.
explain_adjustments: what each adjustment code took away and why.
find_fix: the field-level correction, when the data supports one.
validate_corrected_claim: check the corrected claim before it goes back out.

ClaimFix runs as a hosted MCP your agent can call. It is deliberately narrow: not a billing system, not an EHR, not a dashboard, and it does not submit claims.

Availability: ClaimFix is in development and not yet accepting claim uploads. Practices interested in the pilot can contact scott@smatdesigns.com. Please do not email claim files; they contain protected health information.