Here we will go over the Claims tab, type of claims and how they work
1. This will be the default view when you select the claims tab.
2. By selecting this view, you will have access to the most recent 30 payments and the ability to view "Record insurance payment".
3. This displays your clearinghouse and will direct you to your clearinghouse settings.
4. Here you can view any claims that have been archived.
Next, let's explore each of the six categories, starting with "Transactions Waiting To Be Billed." This category displays transactions from patients with insurance where a claim has not yet been created. If the patient has insurance and pays in full using cash, card, or other means, it will not be included in this list. Only transactions where the service was not fully paid will appear here. You have the option to select any transaction from the list, which will then direct you to the "Edit Service Transaction" page.
From this list, you have the flexibility to choose the box to the right of the transaction or select all, allowing you to effortlessly generate a claim or claims. Alternatively, you can opt for the "Don't Bill Selected Transactions" button, which will promptly remove the selected transactions from the list.
Moving on to the "Unsubmitted Claims" section, you will find a comprehensive list of claims that are prepared for submission but have not yet been sent. This section provides essential information such as the claim ID, claim status, date of service (DOS), creation date, patient name, payer, and amount. Additionally, you have the option to conveniently view the HCFA form from this section.
In the "Claims Awaiting Response" section, users can access a comprehensive list of claims that are awaiting a response from the payer. This section provides important information such as the claim ID, date of service (DOS), date submitted, patient details, payer information, notes, and charges. Claims without a submission date will be prioritized at the top of the list and marked with an exclamation icon. Users also have the option to add any necessary notes to the notes column by clicking on "Empty" or view any existing notes.
Now let's proceed to the "Denied Claims" section, which provides a straightforward display of any claims that have been denied. This section presents a comprehensive list of denied claims, including important details such as claim ID, date of service (DOS), date submitted, patient information, payer details, notes, total charges, and amount paid. You have the flexibility to select any claim from the list, which will then direct you to the "Claims Details" page.
In the "Partial Paid Claims" section, you will have access to a list of claims that includes the claim ID, DOS, date submitted, patient information, payer details, notes, total charges, and amount paid. From here, you have the option to select the "Payment received" payment to distribute the payment accordingly. Additionally, you can also view the HCFA forms from this section.
Finally, we have the "Approved Claims" section. This section provides a comprehensive list of all approved claims, displaying important information such as the claim ID, date of service (DOS), date submitted, patient details, payer information, notes, total charges, and amount paid. From this list, you have the flexibility to select any claim and it will redirect you to the "Claims Details" page where you can manage the payment distribution. Additionally, you can also choose the checkbox next to any claim to access options such as printing, deleting, or archiving the claim.
To conclude our exploration of the claims tab, we have covered all the important aspects and functionalities it offers.