A universal, provider-ready claims intake and resolution workflow designed for modern billing teams.

The Claims Intake & Workflow Form Template is a professionally designed, 2-page Canva-editable templatecreated to help healthcare providers, medical billers, and revenue cycle teams capture, track, and resolve insurance claims efficiently—from intake through follow-up and denials.

This template was built using real-world claims workflows, not generic patient intake forms, making it ideal for claim submission, corrections, follow-ups, underpayments, and appeals across all payers and claim types.

What This Claims Intake Template Helps You Do

Healthcare claims are often delayed or denied due to missing information, inconsistent documentation, or lack of ownership. This workflow template solves that problem by giving your team a standardized intake and action process that works regardless of payer, specialty, or claim type.

With this form, you can:

• Capture all critical claim data in one place
• Standardize how claims are reviewed, followed up, and escalated
• Reduce missing or incorrect claim information
• Improve communication across billing and administrative teams
• Track next actions and follow-up dates with clarity

What’s Included

✔ Claims Intake & Workflow Form (2 Pages)

Page 1 – Claims Intake (Core Information)

• Patient & insurance information
• Provider & facility details
• Claim identifiers and dates of service
• CPT/HCPCS, modifiers, diagnosis codes, and charges
• Claim type (Professional or Institutional)
• Intake date, priority level, and staff assignment

Page 2 – Claims Resolution (If Applicable)

• Denial and issue details
• Filing limit and denial dates
• Documentation and attachment checklist
• Internal notes and claim strategy
• Clearly defined next action selection
• Follow-up date tracking

Who This Template Is For

This template is designed specifically for:

• Medical billers
• Revenue cycle management (RCM) teams
• Independent billing consultants
• Small to mid-size healthcare practices
• Healthcare administrative and operations teams

Whether you manage a handful of claims or a high-volume workflow, this form provides structure without adding software or complexity.

Key Features

• Universal & payer-agnostic – works for commercial, Medicare, Medicaid, and marketplace plans
• Canva editable – customize branding, fields, and layout with ease
• Print or digital use – flexible for any workflow environment
• Professional, compliance-aware design
• Internal workflow tool – not payer-facing

Why This Template Is Different

Most claims tools are either:

• Overly complex software systems, or
• Oversimplified forms that don’t reflect real claims work

This template bridges the gap by offering a clean, practical workflow tool that supports how billing teams actually operate—especially during follow-ups, denials, and corrections.

It’s not just an intake form.
It’s a claims control and documentation system.

File Format & Access

• Editable Canva template
• Instant digital download
• Canva account required (free or paid)

Important Notes

• This template is for internal workflow and documentation purposes only
• Not intended for direct submission to insurance payers
• Does not provide medical, legal, or billing advice