Medical reimbursement claim

How do we take a medical reimbursement claim with the documents set by the request type, chase the missing reports and invoices, and get it into claims inside the prompt pay period?

Classify the request first and ask only for what that type needs. Callvu identifies the member and prefills the policy and the benefit, classifies the request (a consultation, a procedure, a prescription, an emergency abroad, a dental or optical benefit) to set the documents required (the itemized invoice, the receipt, the medical report or referral, the prescription), takes the claim on a secure screen with the uploads, reads each document on arrival and checks it against the request, chases what is missing from the member or the provider through a link, and writes the complete claim to the claims system with the prompt pay clock started from receipt.

In scopeComplex: multi-party handoffsCallvu moves: classify, chase and verify, write back

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Last updated November 7, 2026.

The problem today

The member uploaded a receipt without the itemized invoice, waited three weeks, and was asked for the invoice by letter.

Today, without Callvu

A member pays a provider and claims the money back. The claim form is the same for every request, so the member attaches what they think applies. The claims clerk opens it days later, finds the itemized invoice or the medical report missing, and writes to the member. The prompt pay period has been running since receipt, and the member calls to ask why nothing has happened.

State prompt pay rules require a clean claim to be paid or denied within a set period from receipt (thirty to forty-five days in most states), a request for the missing information within a shorter period, and interest on late payment. The documents that make a claim clean depend on the request type: a consultation needs an itemized invoice and a receipt, a procedure also needs a medical report or referral, a prescription needs the prescription and the pharmacy receipt. The classification is the first step, and it decides the list.

A clean claim on day one is a paid claim inside the period.

How it runs

From the requestto the system of record.

A member submits a reimbursement claim online, in the app, by phone or through an AI assistant. Callvu identifies the member and opens the claim.

Member: Submits the claim and the documents on a secure screen, and provides what is missing through a link.
Provider: Provides an itemized invoice or a medical report where the member cannot, through a link.
Claims assessor: Receives the complete claim and decides exceptions in the Decision Desk.
Callvu: Prefills, classifies, reads and checks documents, chases, and writes back.

Prefill and classify
The member's policy, the benefit schedule, the deductible position and the prior claims are prefilled; the request is classified (consultation, procedure, hospitalization, prescription, dental, optical, emergency abroad, other) from the member's answers and the first document, and the classification sets the documents required and the benefit rules that apply.
Capture with the right questions
The member answers only the questions the type needs (the provider, the date of service, the diagnosis or reason where the benefit requires it, whether another insurer or an employer plan paid first) and uploads the documents on the same screen; each document is read on arrival (the provider, the amount, the date, the itemization, the currency) and checked against the answers and the benefit.
Chase and verify what is missing
A missing or unreadable document is requested with the specific item from the member, or from the provider where the member authorizes it, through a link with reminders; the request for missing information goes out within the state's period and the clean-claim date is recorded when the last item passes.
Write back
The complete claim with its classification, documents and clean-claim date is written to the claims system for assessment, routed by benefit type and value; a claim with a coordination of benefits question, a benefit limit reached, or an excluded service goes to the claims assessor in the Decision Desk with only the allowed outcomes.

Where it ends: The member was asked only for what the request type needs, the missing items were chased within the period, and the claims system holds a clean claim with the prompt pay clock from receipt. The Decision Trace shows the classification, the document checks and any exception; the Audit Trace shows the receipt, each upload and request with their times.

Runtime enforcement

What is enforcedwhile the work runs.

The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.

Regulations

State prompt pay rules (for example New York Insurance Law 3224-a, Texas Insurance Code 1301.103, California Health and Safety Code 1371 and Insurance Code 10123.13): A health insurer must pay or deny a clean claim within the state's period from receipt (thirty days for electronic and forty-five for paper claims in several states), must request any missing information needed to adjudicate within a shorter period (often thirty days), must pay interest on claims paid late, and must not request information already in its possession; the receipt date starts the clock whether the claim is clean or not.
The policy's benefit schedule and claim conditions: The policy sets the documents required for each benefit (itemized invoices, receipts, medical reports, prescriptions), the time to submit a claim after the service, the deductibles and limits, and the coordination with other coverage; the classification applies the schedule.
HIPAA privacy and state health data rules: The member's medical information is handled under the privacy rules, captured on a secure screen and never in an open chat; PHI masking applies in the records.

Company policies

The request is classified before any document is asked for; the member sees only the list for their type.
A document is read and checked on arrival, and the member or the provider is asked for a specific item, never for the whole form again.
The clean-claim date is computed by the process and visible to the assessor.
The claims system is the system of record for the claim and the clock.

Controls

Prefill of policy, benefit and deductible position.
Request classification with the document list.
Document reading and checks.
Missing-item chases within the state's period.
Clean-claim date computation.
Claims system write with Decision Desk for exceptions.

Clocks and deadlines

State prompt pay rules: Pay or deny a clean claim within the state's period from receipt, commonly thirty to forty-five days, with interest on late payment.
Request for missing information: Within the state's shorter period from receipt.
Document reminders: On the carrier's schedule until the list is complete.

Documents and checks

The classified request
The itemized invoice, receipt, medical report or prescription as the type requires
The missing-item requests and responses
The clean-claim date
The claims system record

In the Decision Trace

The classification and the list it set.
Each document's check.
Any exception decision and the person.

In the Audit Trace

The receipt with time.
Each upload and request with time.
The write.

The handoff

Between the front doorand the back office.

The front door

Online, the app, a call or an AI assistant; the documents and medical details on a secure screen.

The back office

The assessor receives clean claims by benefit type with the clock visible; exceptions only in the Decision Desk.

The Decision Desk

A coordination of benefits question, a limit reached or an excluded service goes to the claims assessor in the Decision Desk with the claim and only the allowed outcomes: approve, approve partially with the reason, deny with the reason, or request a named item.

Proof

In scope.Proof at scale, not one process at a time.

The kind of process Callvu runs in production for customers in this industry. Ask for a reference on this exact process. The results below are the industry's published proof; each claim code links to its record on agents.callvu.com.

Phoenix put more than 100 processes live in under 3 months.

Across Callvu customers

More than 1,000 processes are live across Callvu customers.

Across Callvu customers

Questions

What buyers ask next,answered plainly.

What documents are required?

It depends on the request type, which the process classifies first: an itemized invoice and receipt for a consultation, a medical report or referral for a procedure, the prescription and pharmacy receipt for medication.

When does the prompt pay clock start?

At receipt, whether or not the claim is clean; the process requests missing items within the state's shorter period and records the clean-claim date.

Can the provider send the invoice directly?

Yes, through a link, where the member authorizes it, and the document is read and checked on arrival.

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