This will walk you through generating a claim in our new billing.
Submitting an insurance claim can be a smooth and uncomplicated process if the patient has all the required information completed beforehand. It is important to ensure that the case type contains the correct information, as the HFCA form will extract some of the details from here.
Next, you should navigate to the "Policies" section within the "Insurance" tab. Here, you can input and review all policies, including current and expired ones. If the patient holds multiple policies, the primary policy will be displayed at the top, followed by the secondary policy directly below, with any additional policies listed further down. You can identify the primary policy by the "P" next to it, while the secondary policy will have an "S" designation, and any others will be marked with an "O".
Once all the necessary information has been entered, filing a claim becomes a straightforward process. Begin by accessing the billing ledger and choosing the service for which you wish to initiate a claim. Next, select the service or services by checking the corresponding box(es), then, from the "Insurance" drop-down menu, choose "Start Claim" to proceed.
Next, a new screen will appear, displaying the number of transactions selected for the claim and prompting you to verify or select the primary insurance. Please note that the "Business Entity" feature is only applicable to offices with multiple locations.
After clicking on "Create Claim (s)," you will be directed to the "Claim Generation Summary" screen. This screen will indicate whether there are any errors present in the claim you are generating. If no errors are found, the following information will be shown.
In case any errors are flagged with the claim, you will be directed to a screen where you can choose the claim to review and address the errors.
Selecting "Review Errors" will guide you to a new screen that displays all errors associated with the claim.
If there are no errors to address, proceed by selecting "Confirm & Generate" to review the claim information. After reviewing, click on "Create Claim" to finalize the process.
After generating the claim, the following screen will display the confirmation and provide an option to review the HFCA if desired. Additionally, there is a button available for reviewing unsubmitted claims.
Once the claim has been generated, it will appear in the "Claims" section under the "Insurance" tab. If you are sending HCFA forms via fax, initially, the claim will show as unsubmitted.
If the office has a clearinghouse integrated with the software, it will promptly indicate that it is awaiting a response.
All claims, whether submitted electronically or manually, can be monitored in the "Claims" tab located on the left-hand side of the software portal. Claims submitted manually will need to be processed through the claims screen by selecting the claim and marking it as "Payment Received."
In this scenario where this has been done manually, all information received from the payer will need to be entered manually.
After entering the information, you are now able to proceed with distributing the payment. For electronic submissions, all these details can be found in the "Claims" tab, where they will be marked as approved and the distribution process can be completed from there.
