Ottehr Billing Changelog v1.44 - October 7, 2026

Summary

Ottehr Billing is the revenue cycle management application purpose-built to work with Ottehr EHR and Oystehr APIs. It runs as its own application at its own address (for example, billing.yourdomain.com). It uses single sign-on (SSO) with the EHR and is available to users with the Billing Admin role. This first changelog covers everything included through v1.44, spanning the full claim lifecycle from the signed encounter through insurance payment and patient collections.

How it works

When a provider signs an encounter in the Ottehr EHR, a claim is created in Ottehr Billing automatically. Configurable rules then check, price, and route each claim, holding it for review when something needs a biller's attention. Claims are submitted to payers through the clearinghouse, using Oystehr's RCM service. Returning ERAs are matched to claims automatically, which updates payment amounts and claim status. Remaining patient responsibility flows into the EHR's patient balance and invoicing features. Reports summarize payments, collections, and team activity.

Ottehr Billing is designed to make claim preparation, submission, and invoicing as close to touchless as each billing team wants. Billers set up rules that take over repetitive work, so fewer claims need attention over time. Every change to a claim is recorded in its history, whether a biller or a rule made it.

Practices can send signed encounters to Ottehr Billing, to their existing RCM integration, or to both, which allows a gradual transition (#7197 (opens in a new tab)).

On the roadmap

Upcoming work includes:

  • Manual entry of ERAs received on paper or as PDFs
  • Actions on multiple claims at once
  • An aging receivables report for insurance
  • Eligibility checks within the billing workflow
  • Import and sync of provider and facility data
  • A claim review rule powered by Oystehr AI

Claims

Finding and exporting claims
Creating and editing claims
Notes, attachments, and history
Submitting claims
Institutional claims

Claim Creation Queue

Patients

Insurance Organizations

  • Insurance Organizations lists the payers available through the clearinghouse, with their payer IDs, and can be searched by name (#9422 (opens in a new tab)).

  • Practices can add custom payers for insurers outside the clearinghouse. Each custom payer records:

    • insurance types (workers' compensation, auto, medical, or other)
    • submission method and its details
    • the claim form it accepts (CMS-1500, CMS-1450, or other)
    • notes and contacts

  • Custom payers appear in payer searches in both Ottehr Billing and the EHR (#9422 (opens in a new tab), #9424 (opens in a new tab)).

    Billing Insurance Organizations
    Billing Insurance Organizations

Providers and Facilities

Billing and rendering providers
Service facilities

Non-Insurance Orgs

  • Practices can maintain a directory of organizations that pay for care outside insurance, such as employers, with an address and contacts. An Employer toggle marks organizations that are employers (#8937 (opens in a new tab), #9609 (opens in a new tab)).

  • Each organization records how to bill it for workers' compensation, occupational medicine, or another named arrangement:

    • Workers' compensation can route to an insurance payer through the clearinghouse, or be billed to the organization directly.
    • Direct billing records a preferred method (email, online portal, fax, or mail) and the details for each channel (#8937 (opens in a new tab)).

  • Billers can assign an organization to a claim and use organizations in rule conditions and actions. Assigning an organization doesn't change the claim's AR stage or insurance payer (#9299 (opens in a new tab)).

  • The EHR can use these organizations in registration paperwork and visit details, in place of its own employer list. When registration names an organization with a workers' compensation payer, that coverage is added to the patient automatically. This is controlled by a setting and is off by default (#8938 (opens in a new tab)).

    Add Non Insurance Organization
    Insurance Organization

Charge Masters

ERAs

Tags

  • Tags are reusable labels for organizing claims, each with a description and a usage count (#7160 (opens in a new tab)).

  • Four system tags are applied automatically by the system and by rules: Hold, Auto Accident, secondary-submission, and waiting-for-non-primary-ERA. They can't be edited or deleted. Auto Accident is applied from the visit's appointment details (#8669 (opens in a new tab), #7944 (opens in a new tab)).

    Add Tags
    Add Tags

Reports

  • Reports run in the background and are cached, so billers can revisit results without waiting. Billers can view previously run reports or run a new one for a different time range (#9668 (opens in a new tab)).

  • The Payments Report shows insurance payments from posted ERAs, grouped by payer, with billed, allowed, paid, and check totals. It also covers patient payments, plus a view of insurance payments by month of service against month of payment (#7125 (opens in a new tab)).

  • The Invoice Report lists due and past-due patient invoices, broken down by upcoming, past due without a card on file, and failed payments. It also groups outstanding invoices by age (0 to 30, 30 to 60, 60 to 90 days, and older) and shows a month-end trend (#7125 (opens in a new tab)).

  • The Credit Cards on File Report lists patients with their card-on-file status and last visit.

  • The Net Collections Report shows the practice's net collection rate (#9670 (opens in a new tab)).

  • The Pipeline Report shows claims by AR stage and status across the insurance, patient, and non-insurance pipelines.

  • The Productivity Report shows claim actions by user (creates, updates, status changes, submissions, and notes), drawn from claim history.

    Billing Reports
    Billing Reports
    Sample Billing Payment Report
    Sample Billing Payment Report

Rules

Claim Submission Rules
  • Claim Submission Rules run in the specified order before a claim is submitted. Each rule checks its conditions and applies its actions. A rule can take different actions depending on which conditions a claim meets, so one rule can handle several cases. A claim that needs attention is held with the Hold tag (#8604 (opens in a new tab)).
  • Conditions can match nearly any claim property. That covers:
    • claim basics: type, service, dates, billed amount, codes, and place of service
    • tags and status
    • patient demographics
    • primary and secondary insurance
    • providers and service facility, down to NPI, tax ID, taxonomy, and CLIA
  • Comparisons fit the data (amounts, dates, lists, text, and regular expressions). Property labels make clear whether a field refers to primary or secondary coverage (#8672 (opens in a new tab), #8927 (opens in a new tab), #9207 (opens in a new tab), #9362 (opens in a new tab), #9595 (opens in a new tab)).
  • Actions can:
    • set any editable claim field
    • apply tags
    • add, update, or remove service lines
    • swap the rendering provider, billing provider, or service facility
  • Dedicated actions set prices from the charge master and place of service from the service facility. New service lines can take their date of service from the claim, from the first service line, or from a set date. They can include the primary diagnosis, all diagnoses, or specific ones (#8672 (opens in a new tab), #8891 (opens in a new tab), #8892 (opens in a new tab), #9114 (opens in a new tab), #9116 (opens in a new tab)).
  • Rules can't reference a payer, tag, provider, or facility that doesn't exist. If an action can't be applied to a claim, the claim is held rather than partially changed (#8672 (opens in a new tab)).
  • Institutional claim fields and revenue codes are available as both conditions and actions (#9189 (opens in a new tab)).
  • Rules can match and change a large number of claim details, so a complete reference is available that lists every condition, comparison, and action in plain language. It's produced automatically from the product itself, so it always matches what the rule builder offers. Billers and administrators setting up rules can use the billing rules reference (opens in a new tab) in the Ottehr repository to see every option in one place (#8672 (opens in a new tab)).
Pre-invoice rules
  • Non-Insurance Payer Pre-Invoice Rules and Patient AR Pre-Invoice Rules work the same way for claims billed to organizations or patients. Claims that pass move to ready to invoice. These rules run for manually created claims as well (#8670 (opens in a new tab), #8722 (opens in a new tab)).

Working with the Ottehr EHR

Changelog