Once you have your setup complete, and providers have added items in the register/ledger or checked out an appointment with billing information, you will be able to file and process your claims. This workflow will outline how to file a HCFA-1500 form using the Preliminary Claims Queue.
Access the Preliminary Claims Queue
- Navigate to the "Claims Manager" by selecting the icon in the top right corner.
- Select "Reports."
- You are now in the Preliminary Claims Queue.
From here you can review all services with the appropriate notifications and alerts, and will allow for minor service edits. This makes 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 the same time. This will allow you to manage the creation of claims across a range of clients from one place, rather than opening the claims manager for each client individually. All claims generated from this view are sent with one service per claim.
- Select the desired "Facility."
- Select the desired "Service Dates."
- Select "Generate Report."
- You can now review your claims.
This report will show you all of the preliminary claims, and will display all charges that qualify to create a claim, including a payer, a clinical ledger code, and a facility at the time of the charge.
When reviewing the claims, the yellow lines indicate that all of the required information is included. The red lines indicate that there is missing or invalid information, and the data area will that needs to be updated will be marked with a triangle warning. Any red triangle warnings will prevent claims from being created. Hovering over the triangle will display a message conveying what is needed. Some adjustments can be made by selecting the edit icon on the left column of the claim, other items will need to be updated from the client's page.
You can adjust any claim by selecting the edit icon in the left column of the claim row.
The items that can be adjusted here include the "Service Facility", "Place of Service", "Service Date", "Memo", "Modifiers", and "Diagnosis.
Any demographic information will need to be adjusted from the clients "Edit Contact" page.
To edit the "Service Code", "Provider", "Units", or "Charge" select the "Edit Details" for the "Service Information." This action will void the existing entry and create a new entry.
Once you have made the necessary adjustments you can now process these claims.
- Select the claims you would like to create or release.
- Select the "Process Selected" button.
- Then select either "Create Claims" or "Release Claims."
Selecting "Create Claims" will put it in a pending status, but doesn't send it to the electronic claims vendor. This will indicate that the claim has been reviewed and created, but not sent. This is beneficial when there are multiple staff members involved in the billing process. For example, one staff member performing initial review, and another performing final review and releasing the claim.
Selecting "Release Claims" will create the claim and send the claim to your electronic claims vendor.
If you choose to select "Create Claims" those claims will still need to be released.
- Navigate to Claims Manager.
- Set the "Claim Status" to "Pending."
- Select "View All" or;
- Select the "Claim Date" range and select "Go."
- Select the patient's name to make any necessary adjustments if needed.
- Select the claims that you would like to release.
- Select "Release Selected."
- Wait for the confirmation message to appear and select "Ok" before moving forward.
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