Altera Digital Health billing services for hospitals and large groups
We work inside your Altera Digital Health system through named, two-step accounts you control, after a signed BAA. We review charges, submit claims through your clearinghouse, post remittances and work denials and A/R, matching our process to your build.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026
In short: we work in your Altera environment with our own named user accounts, in the queues you assign, and report from your own data. We never claim a vendor partnership, and every billing rule here comes from CMS or X12.
What is Altera Digital Health and who uses it?
Altera Digital Health Inc. sells hospital and physician-practice software. On its own site it lists three EHR lines: Sunrise for midsized hospitals, Paragon Denali for rural, critical access and community hospitals, and TouchWorks EHR for large, multidisciplinary practices.
It also sells Ventus, a set of financial and administrative tools, plus CareInMotion for interoperability and Altera Lab for laboratories.
| Product line | How Altera's site describes it |
|---|---|
| Sunrise | A complete clinical and financial platform for midsized hospitals. Its Financial Manager module is described as centralized billing and work queue management. |
| Paragon Denali | A software-as-a-service, cloud-native EHR with a financial system that includes Patient Management, Registration, Resource Scheduling and Claims Management modules. |
| TouchWorks EHR | A platform for large, multidisciplinary practices that supports independence, with financial and analytical insights for practice administrators. |
| Ventus | Financial and administrative solutions, including Intelligent Coding, Compliance Advisor, Contract Management and Revenue Aware. |
Does Altera produce UB-04 and CMS-1500 claims?
Altera's public pages do not publish a claim-form specification, so what your system sends depends on how your hospital built it, and we confirm it from a sample claim at setup. The form rules come from CMS and X12 and are the same in any system.
A hospital bills facility services on the UB-04. The Medicare Claims Processing Manual, Chapter 25, calls it a uniform institutional provider bill suitable for billing multiple third-party payers. Electronically it travels as the X12 837I, and 45 CFR 162.1102 names ASC X12N/005010X223 as the institutional claim standard.
Professional services go on the CMS-1500 or the 837P, which 45 CFR 162.1102 ties to ASC X12N/005010X222. A hospital running Paragon or Sunrise with employed or ambulatory providers can therefore send both claim types from one organization, and each needs its own checks.
For a critical access hospital, our critical access hospital billing rules page covers the payment side.
How do we get access to your Altera system?
Setup runs on accounts you own. We begin only after a Business Associate Agreement (BAA) is in place, and every person on our team signs in as themselves.
Your administrator can disable any of our accounts whenever needed. Our security page lists the protections we apply.
What do we do inside Altera for a hospital or practice?
Our job covers everything from a posted charge to the money in the bank, run through your Altera system, your clearinghouse and your payer portals. Claims are sent within 24 hours of charge entry, and denials are worked within 48 hours.
- Charge review. Before a claim is built we look for missing lines, wrong revenue codes and absent modifiers.
- Claim edits. Altera describes embedded claim edits and work queue prioritization in Sunrise Financial Manager. We fix what triggered each edit, such as a missing authorization number, rather than only clearing the flag.
- Submission. Claims leave through your own clearinghouse, so existing payer enrollments are untouched.
- ERA posting. ERA files (X12 835) are posted claim by claim, with each payment and adjustment matched.
- Denial work. Denials are grouped by payer and reason, and appeals go out with the supporting chart.
- A/R follow-up. Open accounts receivable are chased by payer and age, with the biggest and oldest first.
- Patient statements. Statements and patient billing questions follow a process you approve.
For the wider picture, see hospital and facility billing and revenue cycle management. We describe similar setups for MEDITECH, Oracle Health, Epic and TruBridge.
Which reports do we pull to track denials and A/R?
Altera's public pages do not list report names, so we describe reports by purpose and map each one to the name in your build.
| Purpose | What it tells you | How often |
|---|---|---|
| Charge lag | Gap between service date and charge entry, per department | Weekly |
| Claim status | Where each claim sits: not billed, sent, accepted or rejected | Daily |
| A/R aging by payer | Unpaid balances per payer, split into age bands | Weekly |
| Denial trends | Denial counts by payer, reason code and department | Weekly and monthly |
| Payment variance | Actual payment against expected payment, per payer | Monthly |
| Unposted payments | Payments received but not yet matched to a claim | Daily |
If your hospital uses Ventus Contract Management, which Altera describes as helping calculate expected reimbursements, its expected amounts can feed the payment variance report. For out-of-network cases, we pull the claim and remittance data our out-of-network billing and IDR work needs from the same reports.
What billing checks matter most in Altera?
We do not attribute a billing defect to Altera. These are checks we run on any hospital system, each tied to an official rule.
| Check | Why it matters | Source |
|---|---|---|
| Type of bill | Form locator 4 holds a four-digit code that identifies the facility type, the type of care and the bill sequence, so a wrong digit changes how the claim is handled | Medicare Claims Processing Manual, Chapter 25 |
| Revenue code lines | Each charge in FL 47 needs a revenue code on the adjacent FL 42 line, and revenue code 0001 stands in for the total line | Chapter 25 |
| Authorization number | FL 63 carries the payer's authorization or referral number when one was assigned, so a missing number can stall the claim | Chapter 25 |
| Two claim types | Facility lines belong on the 837I and professional lines on the 837P, each under its own X12 guide | 45 CFR 162.1102 |
| Remittance format | Health plans send remittances in the X12 835, so posting rules must map its adjustment groups and reason codes | 45 CFR 162.1602 |
A claim scrubber catches some of these before the claim leaves. We add standard claim validation on top and watch the first remittances after any upgrade or build change.
Is Altera software on the ONC certified list?
Altera's ONC Regulatory Compliance page says it offers products on the Certified Health IT Product List (CHPL), the listing of health IT certified under the Office of the National Coordinator program. It names Sunrise, Paragon Denali and TouchWorks EHR versions. We state no certification criteria for Altera and ask for your certified product listing at setup.
How we handle billing in Altera
Our people sign in to Altera under accounts you issue, work the queues you hand over, and report from your own numbers.
We align each EHR, clearinghouse and payer portal workflow with verified team experience, standard claim validation, reconciliation controls and performance monitoring. We follow claim-form and payer rules, whichever Altera line you run.
Want to walk through your Altera setup? Book a call.
- Altera Digital Health · Altera Digital Health
- Sunrise · Altera Digital Health
- Paragon Denali · Altera Digital Health
- TouchWorks EHR · Altera Digital Health
- Ventus · Altera Digital Health
- About Altera · Altera Digital Health
- ONC Regulatory Compliance · Altera Digital Health
- Medicare Claims Processing Manual, Chapter 25: Completing and Processing the Form CMS-1450 Data Set · CMS
- 45 CFR 162.1102, Standards for health care claims · eCFR
- 45 CFR 162.1602, Standards for EFT and remittance advice · eCFR
We check every rule, code and deadline against the official source. See our editorial policy.
Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01Can an outside billing company work inside Altera Digital Health?
Yes, if your organization grants access. Your administrator creates a named account for each person, limited to billing roles, after a BAA is signed. We use those accounts and never a shared login, so your audit trail shows who did what and when.
02What access does a billing partner need in Altera Digital Health?
Access to charge entry review, claim edit queues, claim status, remittance posting and denial lists, set by role. We do not need clinical access beyond what coding questions require. You decide the roles, and every account uses two-step login that you can switch off at any time.
03Which Altera Digital Health reports matter for denial and A/R tracking?
The ones that show charge lag, claim status, A/R aging by payer, denial trends by reason code, payment variance and unposted payments. Altera's public pages do not name its reports, so we map each purpose to the report names in your own build during setup.
04How does Altera Digital Health post ERA and 835 remittances?
Altera does not publish its posting steps, so we confirm at setup how your build posts. Payers send remittances in the X12 835 format that 45 CFR 162.1602 names, and we post those against claims in your system, matching payments, adjustments and reason codes. Anything that does not match goes to an unposted payments list.
05What billing mistakes are common in Altera Digital Health, such as charge capture, modifiers or demographics?
We do not blame a vendor for them. The usual failures are in any system: missing charges, wrong revenue codes, absent authorization numbers and registration errors. We run checks on each before submission and trace denials back to the cause so your team can fix the source.
06Is Altera Digital Health data safe with an offsite billing team under a BAA?
We sign a Business Associate Agreement with every client first. Staff have HIPAA training and NDAs, every system uses two-step login, backups are encrypted, and a compliance officer oversees it. Your administrator controls accounts. See our security page for details.
07Does Altera Digital Health produce UB-04 institutional claims as well as CMS-1500 professional claims?
Altera does not publish a claim-form specification, so it depends on your build and we check a sample claim at setup. Hospitals bill facility services on the UB-04 (837I) and professional services on the CMS-1500 (837P). We confirm during setup which claim types your Altera system sends and check each.
08How do we pull NSA and IDR dispute data out of Altera Digital Health?
We pull claim, remittance and denial data from your reports: dates of service, billed and paid amounts and reason codes. Altera does not name a dispute report, so we build the case file from those pulls. See our out-of-network billing and IDR page.
09Is there a billing company that works in Altera Sunrise, Paragon or TouchWorks?
Yes. Nucleus Align works inside Altera Digital Health on accounts you create, so you keep your system. We work the facility and professional billing queues you assign in your Altera environment, covering claim checks, ERA posting, denials and A/R follow-up. Claims go out within 24 hours of charge entry and denials are worked within 48 hours.
10Do we have to share our Altera Digital Health passwords with a billing company?
No. You create separate named Altera Digital Health users for the Nucleus Align team, with only the access you choose, plus two-step login and a signed BAA first. Your Altera team sets the role-based access. Your own staff keep their logins, and you can end ours whenever you decide.
Running Altera Digital Health? Talk to us.
A 20-minute call about your payers, volume and setup. Monday to Friday, 9am to 5pm Eastern.