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Release Claims to Insurance Vendor Software


Users, who have permissions to manage and release claims for the whole company, will click on the blue dollar sign in the top right of the dashboard calendar screen.  This opens your web browser, click Remember and Launch if prompted:




As needed, review the claims by clicking on the client’s name. If no edit is required, click Close to return to the claim manager. Click Save and Close after edits are made.





To send out claims to the Insurance Vendor Software (1500 HCFA only):


  • Check claims individually.
  • Check the grey facility header to automatically have all claims for that facility selected.
  • Check the Select All next to the Release Selected button to automatically have all claims for all facilities selected.



Once the needed claims are checked, click the Release Selected button to send out these claims to the clearinghouse. These claims will receive the delivered status. 



















Navigate to the Claims manager for the whole company (opens your web browser, click Remember and Launch if prompted):




In the upper-right, click on the Reports button:




Select the report:




To return to the start, click on the Reports button and select Claims Manager.




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Preliminary Claims Queue



The purpose of the Preliminary Claims Queue report will be to preview all services with the 
appropriate notifications and alerts, make it convenient to resolve issues where possible and provide a  way to push the services to claims with the option to release those claims at that time. This will allow companies using BestNotes billing functionality to manage the creation of claims across a range of clients from one place (as opposed to opening the claims manager for every client individually).

  • Select Facility
  • Service date(s) - defaults to the last 3 days
  • Select View:



  • When ready, click Generate Report


Doc Status: 
If entry is associated with log entries (e.g. via calendar appointment), the document/signature status of that/those entries 


  • Log entry/entries are still unlocked
  • Log entry/entries are locked, but signatures are still pending 
  • Log entry/entries are locked and all signatures have been added 

NOTE: Add-on codes for a service are displayed in the same row as the parent service. The total charge column for that service includes the charges for the main service and all of the add-on codes as well. 


Authorizations:

If the company is using the BestNotes Prior Authorizations system, the authorization number for the service will also be displayed. For more documentation, click HERE.

Service Data Validation:
If the service is missing one or more data points, or one or more of the data points provided for that service is invalid, the checkbox for that service row is disabled and the user cannot select that service for claim generation. That service row will be highlighted in red, and a icon will be placed next to the relevant data point in that service row that is missing or has invalid data. Hovering the mouse cursor over the icon will provide some helpful information on what step(s) need to be completed to satisfy that data points validation:






NOTE: For Client's, who do NOT have insurance, check the Cash Only box.





Report Views:


The “View” filter option allows the user to specify one of several sub-sets of services to view in the report: 



  • Preliminary Claims 
    • Services that meet the initial criteria specified above (procedural codes, not voided, haven't been created as a claim), and that aren't indicated as being “Cash Only” will appear in the report. 
  • Preliminary Claims – Problems Only 
    • Same criteria as above, however, only services that have missing/invalid data points will be displayed. 
  • Patient Responsible – w/ Ins 
    • Services that are marked “Patient Responsibility” but the associated patient has insurance information recorded in BestNotes will be shown. This will be an important view for billing personnel to monitor. 
  • Patient Responsible – w/o Ins 
    • Services that are marked “Patient Responsible” and the associated patient does NOT have insurance  information recorded in BestNotes. 
  • Cash Only – w/ Ins 
    • Services that inherited the “Cash Only” status from the patient at the time of service but the patient has  insurance will be shown. 
  • Cash Only – w/o Ins 
    • Services that inherited the “Cash Only” status from the patient at the time of service and the patient  does NOT have insurance will be shown. 
  • Duplicate Service Review 
    • To output the data for this view, BestNotes examines all of the services rendered during the supplied timeframe and for the provided Facility looking for the same service being provided to the same patient on the same day.  




The Preliminary Claims Queue report does not provide a way to cancel/merge the potentially duplicated services; if an erroneous duplication is found, the user will need to use the tools within the patient's ledger to correct the situation. 


NOTE: These potential duplications are not flagged in any way on any of the other views.



Creating Claims:


If a service has been reviewed and is found to be satisfactory, the user can select the checkbox (in the left most column of the service line) to indicate that they wish for that service to be created as a billing claim. 



Clicking the button above the report labeled “Select All On This Page” will check the checkboxes for every service displayed in that page that can be created as a claim. If multiple pages are available, the user would need to navigate to each page and click the “Select All On This Page” button to select all services. Alternatively, they can choose to display “All” services and then would only have to click the button once. 



Once all selections have been made, users should click the “Process Selected” button above the report. This will bring up the “Process Services” dialog box. Here the user can review the number of services and the total dollar amount for the services that will be created as claims. They will also be presented with two options: 



  • Create Claims 
    • Create claims from the selected services and places those claims in the “Pending” state. These claims  can be reviewed from the Claims Manager. 
  • Release Claims 
    • Create claims from the selected services and release those claims to the clearinghouse for processing.
 





After processing the requested action, the “Process Services” dialog will close and the Preliminary Claims Queue report will refresh.









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Beta Reports in development / progress






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Claim Submission Report






Error











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Claim Ack Status Report