CareFlo
Simplify how healthcare businesses exchange claims, billing information, and insurance-related documents. CareFlo is in development and planned for 2027.
Claims and eligibility data, in a format your team can work with
CareFlo is built to translate HIPAA X12 transactions to and from the formats your systems use (JSON, XML, CSV or flat files), validate them before they go out, and track each one through its lifecycle.
Who it's for
- Medical billing companies
- Revenue cycle management (RCM) teams
- Practice management software vendors
- Clinics that manage their own billing
- Health plans and benefits administrators
Claims, payments and coverage checks, in the right format
CareFlo is being built to take claims, payment reports, eligibility checks and enrollment files, translate them between your systems' formats and the HIPAA X12 standard, and send them on.
From healthcare partners
- SFTPSecure file transfer
- APIREST or SOAP
Partners
- Payers
- Providers
- Health plans
- TPAs and clearinghouses
Comes in as
- X12X12
- </>XML
- { }JSON
- CSVCSV
- TXTFlat files
Goes out as
- X12X12
- </>XML
- { }JSON
- CSVCSV
- TXTFlat files
Your billing system sends a claim as JSON. It goes to your clearinghouse as an 837.
To your systems or partners
- SFTPSecure file transfer
- APIREST or SOAP
Partners
- Payers
- Providers
- Health plans
- TPAs and clearinghouses
- Built for HIPAABeing built to meet HIPAA requirements, with a BAA for every customer who needs one.
- X12 5010 translationEvery transaction checked against the X12 5010 rules before it's sent.
- End-to-end workflowsClaims, eligibility, enrollment and payments in one place.
- Status and alertsReceipts, rejections and errors, so nothing gets lost.
- Runs in the cloudNothing to install or keep running on your side.
Illustration of how CareFlo is designed to work. CareFlo is planned for 2027. It is not a clearinghouse: connections to insurers go through your clearinghouse or a partner we help you set up.
A clinic claim, translated
A clinic's 837P professional claim becomes structured data your billing system can read, validate and monitor.
ST*837*0001*005010X222A1~
BHT*0019*00*CLM20261104*20261104*1030*CH~
NM1*85*2*LAKESIDE FAMILY CLINIC*****XX*1234567893~
NM1*IL*1*DOE*JANE****MI*W123456789~
CLM*PT1001*185***11:B:1*Y*A*Y*Y~
HI*ABK:J069~
SV1*HC:99213*185*UN*1***1~
DTP*472*D8*20261103~
SE*9*0001~{
"type": "professional_claim",
"standard": "X12 837P",
"claim_id": "PT1001",
"billing_provider": {
"name": "Lakeside Family Clinic",
"npi": "1234567893"
},
"patient": { "member_id": "W123456789" },
"diagnosis": ["J06.9"],
"services": [{
"cpt": "99213",
"date": "2026-11-03",
"charge": 185
}],
"total_charge": 185
}What we're building
HIPAA X12 translation
Planned support for the 5010 transaction sets billing teams use daily.
Claims
Build and read 837 professional, institutional and dental claims.
Eligibility
Translate 270/271 eligibility requests and responses.
Claim status
Read 276/277 claim status updates and 999 acknowledgments in plain fields.
Remittance
Turn 835 remittance advice into data you can reconcile against.
Enrollment
Send and read 834 enrollment files to add, change or end members.
Prior authorization
Send and read 278 prior authorization and referral requests.
Validation and monitoring
Catch errors before submission and get alerted when something stalls.
Built for HIPAA
CareFlo is being built to meet HIPAA requirements, and we'll sign a Business Associate Agreement (BAA) with every customer who needs one.
Supported transactions
Planned for launch in 2027.
| 837 | Health care claim (professional / institutional / dental) |
| 835 | Claim payment / remittance advice |
| 270/271 | Eligibility inquiry and response |
| 276/277 | Claim status request and response |
| 278 | Prior authorization / referral |
| 834 | Benefit enrollment and maintenance |
| 999 | Acknowledgment that a file was received and checked |
Join the CareFlo waitlist
We'll let you know as soon as CareFlo opens, and early waitlist members get first access.
✓ You're on the list. We'll be in touch from aadithbalaji@nexflo.cloud.