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. The claim column will also indicate how many claims there are to distribute, and how many have been distributed.
By clicking on any payments by the patient's name you can then review them, and then distribute to claims.
Selecting the ID number displayed in blue text will direct you to a new screen, allowing you to initiate the billing process for secondary insurance.
Should there be a need to edit an ERA to rectify the write-off or patient responsibility, please click on the payment amount highlighted in blue text, which will direct you to a new screen for further action.
On this new screen, you will find a detailed breakdown of the amount charged, insurance payments received, patient responsibility, and any adjustments made. Located just above the adjustment field, you will notice an edit icon. Clicking this icon will direct you to the edit insurance payment screen for further modifications.
Here you can now make any edits to the payment that are needed.
Navigating back to the main screen, at the top, next to ERAs you will see the "History" tab. This will display all claims that have been distributed.
Finally, on the main screen, you will find the clearinghouse currently configured for your account displayed adjacent to the history tab. Should any issues arise with your clearinghouse, an alert will be indicated by a caution sign accompanied by an error banner for your attention.
