Billing Step 3 Video

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Billing Step 3 Documentation



Page Content (click on blue titles):







Client Demographics



The final set-up procedure is on each of your clients’ profiles. To keep a claim from being rejected, this demographic information on the Edit Client screen is required: 


First and Last Name, Gender, Date of Birth (DOB), Provider 1, Address (Street and Zip), and Start Date (DOA).







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Client Payers



Under the client's Episode tab, click on the Payers button.




NOTE: The Payers button will only display for users with the Administer Programs permission, located under the Contact’s section



Users with this permission can add multiple payers to a client. Your company will have created a list of commonly used payers so they are available in this list when you add them. You can add companies that are not insurance based, as well. For more information, Click HERE.





NOTE: Payer's must be in the Payer’s list to be used for claims.



Add authorizations, as needed. You can track these by using a template authorization or by creating a new authorization (For more information, Click HERE).



NOTE: An Authorization Numbeis required to save.





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Register / Ledger



A claim pulls diagnosis codes from the Client’s Register tab. These codes must have a Facility added from when the ledger entry was created and be previously linked as Procedural Codes from the Ledger Settings.



NOTE: Ledger entries with Facility and diagnosis codes show on the client’s register tab when created directly in 1 of 3 different locations:


  • Appointments with an attached diagnosis codes (Appointment Types)
  • Templates/Notes from the client’s activity log
  • Client’s Register tab.



Adding a Ledger in the Register tab or on a Note, could do one of two scenarios:


  • If this code has not been identified as a pre-authorized service, you will be prompted that this may have problems in billing.

OR


  • If it has been authorized, the entry will turn green.




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Med/Clinical


  1. Master Tx Plan (MTP)
  2. Does the client have a diagnosis in the BestNotes Master Tx Plan?

NOTE
  • If a diagnosis is not in the BestNotes designated Master Tx plan tab/page/screen, a claim will not be generated correctly. 
  • Check with BestNotes support to make sure the diagnosis is in the right place in case this section was repurposed.



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Claims

Now you are ready for a new claim. While on a client’s profile page, click on the Dollar sign / icon next to the client’s name.





This will open the Claims Manager with the default Pending claims list. For more information about the Preliminary Claims Queue Report, click HERE.

At the top right, click on the New Claim button.





This will take you to the individual claims form which will automatically populate information in the sections of Facility, Patient, Primary Payer, Provider, and Diagnosis.


Manually enter the following:

  • For Claim Type, select UB04 or 1500 (HCFA).
    • For UB04, select the Type of Bill, and ToB-Digit 4 (frequency code).
      • Type a Claim Indicator, as needed.







    • For 1500, select a Place of Service.
      • Typically, 11:Office is the common HCFA.
      • Type a Claim Indicator, as needed.







The individual services at the bottom of the claim are pulled from the client’s register.




NOTE: Some payers only allow one diagnosis at a time.



For 1500 (HCFA), enter a point of service and pointer in your system, as well.





If there are no providers listed on the service level, then the claim level rendering Provider and their NPI will be used on the claim. If the claim level has no provider and NPI listed, then the top level Facility NPI will be used on the claim. All claims require at least the top level facility NPI.





               




Now, either click Save to set this claim as Pending, or if you have more lines to add, click Save and Close to return to the client’s profile / face page.



NOTE: Claims can be sent from an individual Claims Manager. Check out the Preliminary Claims Queue Report for more information (Click HERE).




Once a Ledger is in a claim, the Register tab will add a purple marker on the left-hand side of that ledger: