System & User Flows
Insurance Claims Pipeline
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Insurance claims represent 35% of revenue and are processed entirely digitally via ANSI X12 EDI 837P submissions through the Lynx Services network. The pipeline covers policy verification at booking, claim assembly post-service, EDI submission, remittance parsing, and payment reconciliation.
EDI Standards: Auto Glass uses X12 EDI 837P (claim submission) and 835 ERA (electronic remittance advice) — the same standards used by healthcare billing, adopted by major auto glass insurance networks. Lynx acts as the clearinghouse.
Full Claims Sequence Diagram
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Claim State Machine
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Common Denial Codes & Resolution
| Code | Description | Resolution | Avg Resolution Time |
|---|---|---|---|
CO-97 | Payment adjusted because benefit was already adjudicated for the same service | Verify no duplicate claim; provide work order reference number to Lynx | 3 business days |
CO-4 | Service is not covered by this payer | Verify policy coverage type; convert to self-pay if confirmed non-covered | 1 day |
PR-1 | Deductible amount not collected | Verify deductible was collected; resubmit with corrected deductible field | 2 business days |
CO-B7 | Claim received outside the timely filing window | Appeals must be filed within 180 days with proof of earlier submission | 10–14 business days |
OA-23 | ADAS calibration line item not covered under this policy | Verify policy includes ADAS coverage; offer customer direct-pay option for calibration | 1 day |
Supported Insurance Networks
| Network / Insurer | Integration Method | Assignment Required | EDI Clearinghouse |
|---|---|---|---|
| Lynx Services | REST API + EDI | Yes — before service | Lynx |
| State Farm | REST API (SF Glass Program) | Yes | State Farm Direct |
| USAA | REST API | Yes | Lynx |
| Allstate | EDI via Lynx | Yes | Lynx |
| Progressive | EDI via Lynx | Yes | Lynx |
| Geico | EDI via Lynx | No (open network) | Lynx |
| Out-of-network | Paper / superbill PDF | No | Customer self-files |