Automated Payments & Claims (Osmind 360)

Overview

Osmind automatically handles payment collection and insurance claim submission through your practice's Candid account. This article explains what happens at each step, what your team is responsible for, and how to resolve common issues.

Before you get started

Make sure the following are in place:

• Your Candid account is connected to Osmind

• 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 your Candid account automatically.

⚠ 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. Log into your Candid portal directly to see the more specific status (e.g., Coded, Submitted to Payer).

Your responsibilities as an O360 practice

Because you own your Candid account and payer contracts, your team is responsible for:

• Maintaining your accepted payor list. If a payer isn't correctly mapped, eligibility checks can fail silently and claims can be rejected. Contact Osmind support if you need help correcting a payor mapping.

• Resolving claim error tasks in Osmind. When a sync fails for a fixable reason, a task is created and assigned to your team. Completing the task triggers an automatic retry.

• Working denials. Since you hold your own payer contracts, your RCM team manages denial appeals in Candid.

• Issuing patient refunds. When a patient is owed a refund, your team processes it through your Stripe account.

Troubleshooting

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.

CMS1500 stuck in "Not Sent"

What to check:

• Is the chart note signed and locked?

• Is the appointment marked as Occurred?

• Does the patient have insurance on file with a valid payor ID?

If all three are true and the claim still hasn't synced after the overnight window, contact Osmind support with the CMS1500 ID.

CMS1500 shows "Rejected by Clearinghouse"

A task is automatically created in Osmind when a claim fails to sync. 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"

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.

Payor mapping issue causing eligibility or claim failures

Your practice maintains your accepted payor list. If an eligibility check returns no result or a claim is rejected due to a payor ID mismatch, the payor may not be correctly mapped.

What to do: Contact Osmind support with the payor name and the patient's insurance details. The team can identify and correct the mapping.

Need help?

If a claim has been stuck for more than 24 hours after the overnight sync window, or you're seeing an error not covered here, contact Osmind support with the CMS1500 ID and a description of what you're seeing.