--- title: Insurance Billing | Avara description: Avara RCM insurance billing — prior auth, eligibility, claims, and ERAs. Coming Q3 2026. --- ## Overview The **Avara RCM insurance billing module** is **currently under development** and is expected to be available during **Q3 2026**. It will bring revenue cycle management directly into the Clinical Platform — from verifying coverage before a visit to submitting claims and reconciling payer responses. This page describes the capabilities planned for launch. Detailed setup and workflow documentation will be added as the module ships. ## Planned Capabilities The insurance billing module will support four core RCM functions: ### Prior Authorization **Prior authorization (PA)** is advance approval from a patient’s insurance plan before certain services, procedures, imaging studies, or medications are performed. Payers use PA to confirm medical necessity and coverage rules before care is delivered — reducing denials and unexpected patient liability. In Avara, prior authorization workflows will help your team **initiate, track, and document PA requests** tied to appointments and clinical orders, so authorization status is visible where scheduling and clinical staff already work. Prior authorization will also be available in **[Avara Connect](/connect/overview/index.md)**, so referring organizations and your practice can **verify authorization requirements earlier in the referral path** — before a patient is booked or arrives. That shared visibility cuts back-and-forth between referring and receiving sites and keeps referrals moving without separate phone calls, faxes, or portal logins on each side. See [Referrals](/connect/referrals/index.md) for how Connect referral workflows fit into partner scheduling today. ### Eligibility Checks An **eligibility check** confirms a patient’s **active coverage**, plan details, and benefit information — copays, deductibles, in-network status, and coverage dates — typically before or at the time of service. Real-time eligibility reduces front-desk surprises, supports accurate patient estimates, and helps staff confirm the right payer and member ID before claims go out. Like prior authorization, **eligibility checks will be available in Avara Connect** as well as the Clinical Platform. Referring partners can confirm coverage context **before sending a referral**, and your team can re-verify at intake — **aligning both organizations on the same payer data** and smoothing handoffs between referring and receiving workflows. ### Claim Submissions **Claim submission** is the process of sending **professional or institutional claims** to payers (or clearinghouses) for services your organization rendered. A completed claim includes diagnosis and procedure codes, provider and facility identifiers, dates of service, charges, and supporting clinical linkage where required. The Avara RCM module will support **creating and transmitting claims** from your Clinical Platform workflow — connecting documentation, appointments, and billing data so claims reflect what was actually performed and documented. ### Electronic Remittance Advice (ERAs) An **ERA** is the payer’s **electronic payment and adjustment response** after a claim is processed. ERAs explain what was paid, denied, or adjusted line by line — including reason codes that drive posting, patient responsibility, and follow-up (appeals, corrections, or resubmission). Automated ERA ingestion will help your team **reconcile payments against submitted claims**, post adjustments efficiently, and maintain a clear audit trail from charge through remittance without manual re-keying of payer responses. ## Transaction Enrollments End-to-end RCM requires more than software — your organization must be **enrolled with payers and clearinghouses** to exchange standard healthcare transactions electronically. Avara will support **transaction enrollments** so you can activate the EDI flows your billing team needs without juggling separate vendor relationships for each step. Planned enrollment support includes: - **Eligibility** — Real-time benefit and coverage inquiries (X12 **270/271** transactions) for the eligibility checks described above - **837P** — **Professional** claim submission (physician and other professional services) - **837I** — **Institutional** claim submission (facility and hospital billing) - **837D** — **Dental** claim submission - **835** — **Electronic remittance advice (ERA)** — payer payment and adjustment responses paired with submitted claims Together, eligibility enrollment plus professional, institutional, and dental claim submission plus ERA receipt covers the **full revenue cycle path**: verify coverage → submit the right claim format for the service → receive and post remittance. Avara will guide enrollment and payer connectivity as part of onboarding so your team can run **complete RCM workflows** inside the platform once the module launches. ## Connect and Clinical Platform Together Prior authorization and eligibility are where **Clinical Platform RCM** and **Connect** intersect most directly. Building both into the referral and scheduling path means: - Referring organizations can **validate coverage and authorization needs upstream** - Receiving practices see **consistent payer context** when a referral arrives - Fewer delays from missing PA or stale eligibility at check-in Claim submission and ERA processing remain centered in your organization’s **Clinical Platform billing workflow** — where services are rendered, documented, and reimbursed. Connect extends PA and eligibility **across organizational boundaries** so partner workflows stay as streamlined as in-house ones. ## What’s Next Full insurance billing documentation — payer setup, **transaction enrollments**, claim workflows, ERA posting, and Connect integration details — will be published when the module launches in **Q3 2026**. Until then, contact Avara at if you want to discuss RCM roadmap fit for your organization or early access planning.