Automated Payments & Claims (OCN)

Overview

As an OCN practice, Osmind manages your Candid account, payer contracts, and payor configuration on your behalf. Your team's job is to complete the clinical workflow correctly — Osmind handles everything on the billing side automatically.

Before you get started

Make sure the following are in place:

• Stripe is connected to your Osmind account

• Patients have a credit card saved in the Osmind patient portal

• Providers are creating CMS1500s from signed and locked chart notes linked to the appointment

How payments are collected

Cash pay patients

When you mark an appointment as Occurred, Osmind creates an invoice based on your pricing configuration. If the patient has a card on file, it's charged immediately. If not, an invoice is emailed to the patient.

Insurance patients — copay

Two things must both be true before the copay fires: the appointment is marked Occurred and the CMS1500 is saved. Once both are done, Osmind charges the copay automatically.

The copay amount comes from an eligibility check that runs 3 days before the appointment:

• Telehealth (video/phone): the telehealth copay is used. If none is on file, the in-person copay is used as a fallback.

• In-person: the in-person copay is used. If none is on file, no charge is attempted and a task is created in Osmind.

If the patient has no card on file, an invoice is emailed instead.

Insurance patients — final bill

After the payer adjudicates the claim and Candid marks it as finalized, Osmind pulls the patient responsibility amount overnight and handles collection automatically:

• Patient owes money + card on file: card is charged; receipt emailed

• Patient owes money + no card on file: invoice emailed to patient

• Patient owes $0: no charge, no email

• Patient was overpaid (negative balance): a task is created in Osmind. Your team must issue the refund manually through your Stripe account.

How claims are submitted

Every night, Osmind scans for CMS1500s that are ready to send — chart note signed and locked, appointment marked Occurred, status is "Not Sent" — and submits them to Candid automatically. Osmind's RCM team monitors the queue and manages any issues on the Candid side.

⚠ Do not manually change a CMS1500's status in Osmind. The system reads and writes these statuses automatically. Manual changes will disrupt the pipeline.

Understanding claim statuses

When the status shows Batched, the claim is with Candid but hasn't reached the payer yet. Osmind's RCM team can look into the specific Candid status on your behalf — contact support if you need visibility into a specific claim.

What Osmind handles for you

Osmind's RCM team manages the following on behalf of OCN practices:

• Payor list management and payor ID mapping

• Claim monitoring and error resolution

• Denial management and appeals

• ERA review and posting

Your practice does not need to log into or manage anything in Candid directly.

When your team needs to take action

Osmind creates a task in Osmind when something requires input from your practice. The most common situations are below.

Claim sync error — missing or incorrect patient information

A task is created when a claim can't sync due to something only your team can fix. It will look something like:

Candid Error: Claim sync error for [CMS1500 link]
- Patient is missing primary insurance.
- Service provider zip code must include +4 extension.

Steps to resolve:

1. Click the CMS1500 link in the task

2. Fix the issue listed (see table below)

3. Mark the task as Complete — this automatically retriggers the sync

4. Confirm the CMS1500 moves to "Batched"

Patient has no card on file

What you'll see: Invoice shows as "Outstanding" with no charge processed.

What to do: Have the patient add a card in the Osmind patient portal. Once added, your team can manually apply the payment in Osmind.

Patient is owed a refund

What you'll see: A task in Osmind noting the patient has a negative balance.

What to do: Go into your Stripe account and refund the payment associated with the patient's copay charge.

Copay didn't fire

Both the appointment being marked Occurred and the CMS1500 being saved must happen for the copay to trigger. If the CMS1500 was created outside the normal workflow — not from the chart note tied to the appointment — the auto-payment chain is broken.

What to do: Have the provider create the chart note from the appointment, then create a new CMS1500 from that note. Contact Osmind support if you're unsure.

Need help?

If a claim has been stuck for more than 24 hours after the overnight sync window, or you're seeing a task you're not sure how to resolve, contact Osmind support with the CMS1500 ID and a description of what you're seeing.