Let's take a look at the new insurance claims tab.
Numerous new features and tools have been incorporated to enhance the functionality of the "Claims tab". Let's delve into these latest additions together, starting with an examination of the "Unbilled" section, located as the first tab in the top left corner. This area is designed to display any services that have not yet had a claim generated for them or are not marked as "do not bill".
You can select any services or all and either generate claims or mark as "Don't bill selected" at the bottom of this screen.
Moving forward, let's proceed to the next tab in the top left corner labeled "Claims". Within this tab, we will now analyze the section labeled "Unsubmitted".
This section contains a detailed list of claims awaiting submission. The columns provide information on the date of service, patient, payor, and charges. In the payor column, each payor is identified with a 'P' for primary, an 'S' for secondary, or an 'O' for other. The charges column displays the charges, payments made, 'PR' for patient responsibility, and 'ADJ' for adjustments.
If any boxes on the left are highlighted in red, it indicates an error with the claim. Hovering over the box will display the number of errors present. By selecting a box next to a claim, new options will appear in the bottom right corner, allowing you to electronically submit the claim, mark it as submitted, download it as an EDI, delete it, or print it.
Next, we will explore the section "Waiting". Here, you can easily identify any claims that have encountered errors and check their submission status. If a payment shows up in the "Paid" column you can click on the amount to review and distribute to claims. Distributing to claims moves the claim from "waiting" to "paid". You can also review ERAs in this area.
The section labeled "Partial" showcases all claims with partial payments.
Transitioning to the "Paid" section, this is where you will find all approved and paid claims listed. By clicking on the green amount in the paid column, you will be directed to a new page where you can review the payment.
The "Denied' section will display any denied claims.
Users have the option to archive claims for future reference, which will then be accessible in the "Archived" section.
Now, let's navigate back to the top left corner and access the "ERAs" tab. Here, you can view a comprehensive list of all payments received and also process manual insurance payments if needed. This is downloading the ERAs from your clearinghouse so that you do not need to yourself. You can also search by payer, type, date, and status of complete or incomplete.
By clicking on any payments you can then review them, and then distribute to claims. When distributing a claim you must select and match the claim from the drop-down in the bottom left corner and add claim and then click distribute.
Navigating back to the top left corner and selecting the "History" tab will display the generated claims, showcasing details such as creation date, patient information, claim status (valid, errored, or generated), and the user responsible for its creation.
Once we select generate claim we are taken to a new screen confirming that it was generated without error. You can also review any unsubmitted claims from this screen.
Now returning to the history tab, if we select a claim that has an error we will be taken to a new screen where we can review any errors.
Upon selecting 'review errors', all pertinent information regarding the claim will be displayed, including details on what errors need to be addressed.
When you select create and fix now you will be taken to the HFCA form where the boxes will be highlighted showing the errors that need to be fixed.
Returning to the History tab, if we select a claim that shows in the generated column we will be taken to a screen where we can review unsubmitted. This takes you to the unsubmitted claims area where you can then submit to the payer.
