Topics Send Professional Claims Search:  

Introduction

Send Claims screen displays list of those claims which are raised to Insurance Companies but not yet processed from 'Send Claims' Screen with status 'Ready to Send'.  It also displays list of claims where Secondary Insurance was applicable but after EOB from Primary Insurance of Claim is received.

There are number of validations applied on 'Send Claims' screen in order to check the claims before sending it clearing house. The claims are stopped here if found required information is missing on claims being sent so that it does not get rejecetd by clearing house when received by clearing house. The status is displayed in cloumn 'status' with legends.

There are three radio button which are present on the screen. Whenever an option is selected, the claims are displayed accordingly.

  • New Claims - It will display claims which are in ‘Ready to Send’ status but not yet processed.

  • Overdue – Claims which were sent earlier but EOB/ payment has not been received yet. It is governed by ‘Av. Response Time in Days’ on Insurance Master Screen. ‘Av. Response Time in Days’ is calculated on the basis of ‘Sent Date’ of the posted claim.

  • Resend Unpaid Claims Before – This option is similar to ‘Overdue’ option but major difference being that it does not consider ‘Av. Response Time in Days’. If the option: Resend Unpaid Claims Before is selected then user can edit the Date (if required). The default date is computed as per No of days from the property: Resend Claim Before X Days (i.e. before current date) as found in Billing Parameters, blling.resendclaims.beforexdays. All Claims which were send earlier before the specified date, and where there is NO Remittance against it are listed. The user can select the relevant ones and send the Claims again by EDI Or reprint the CMS and dispatch it.
This screen has four Tabs:

Pri-Edi
Note that Settings > Configuration > Insurance Master screen has a list box to select the Supported by Clearing house. If an option other than 'None' is selected, the Claim is send by EDI to the Insurance, otherwise it is sent by paper CMS 1500 form. This tab displays the list of Claims raised for Insurance Companies which need to be sent out by EDI and whose status is Ready to Send.

Sec-Edi
Once a remittance is received from Primary Insurance, if the Secondary Insurance was applicable and its Supported by Clearing house option was Not 'None', the entry gets generated here.

Pri-CMS
This displays the list of Claims whose status is Ready to Send and whose Primary Insurance does not support any Clearing House.

Sec-CMS
Once a remittance is received from Primary Insurance, if the Secondary Insurance was applicable and its Supported by Clearing house option was 'None', the entry gets generated here.

The fields which are displayed include

Check Box: To select the Claim to send.

Claim Id: The unique Claim Id. This is hyperlinked to take the user to the Claim screen.

Hide Check Box: This marks the Claim as sent without actually sending it out to clearing house. If a User has reopened the claim, to make some small change / comments without materially affecting the claim amounts, it need no actually go out again to the Insurance company. In such a case user check this check Box and process it.

DOS: Date of Service / Encounter Date.

POS: Place of Service Code as selected on the claim screen.

Bill Date: Date on which Claim was generated.

Patient: Name of Patient.

Provider: Name of Provider.

Insurance: Insurance Company Name.

Status: It is the status of claims that will be sent to clearinghouse. The legends displays updated legend number for claims stopped here. The detailed meaning of the legend number is available on pop up 'EDI Readiness Status Legends'. It is invoked by button 'legends'. The status with 'green' background means claim is ready to send and if it is 'red' then it means that claim is not allowed to process due to data missing on claims.

Amount: Charges Billed to Insurance in the Claim. Note that it will Not include the charges billed directly to the Patient in the Claim.

Total: Total Charges for the List displayed. It indicates the Urgency to the Biller.



User can Sort the List on
  • DOS
  • POS
  • Bill Date
  • Patient
  • Provider
  • Insurance

legends: It invokes pop up 'EDI Readiness Status Legends' which displays list of validations and corresponding error code due which claims are held here or ready to be processed. User can use it for referring the details about status displayed in the table.

Select Filter: It invokes pop 'Claim Edit Filter'. There are various fields on which filter can be applied. Enter value in the edit box present next to field. Click button 'Ok' to apply filter on Send Claims screen. Button 'Select Filter' changes to 'Filter' with 'tick mark' icon on the button. It specifies that Filter has been applied.

Total Entries: It is total number of claims displayed on focussed tab.

Total Amount: It is total sum of amount of all the claims displayed on focussed tab.

process: It is useful which can be used to manually process the selected claims displayed on the screen. Although claims are processed auttomatically by self run scheduled process. Select the claims using checkbox and click button 'process' to print either CMS1500 if it is paper claim or send claim by EDI.

Note: 'Self Pay' claims are not allowed to process.