This page will instruct you how to view/work your Accounts Receivable.
|This tab displays all claims that have un-settled balances (i.e. open claims; A/R). These are claims that have either an insurance balance or a patient balance. The tab will let you make payments, check real time status on claims (if supported), and retrieve any payer reports.|
- To view your Open Claims (A/R) click on Billing button .
- Click on the left side of your screen select the Claims + A/R tab .
- Next to the Stage drop-down menu, select All daysheeted claims (A/R).
- Under the Claims + A/R tab, you have the following options to view your open claims:
- Isolate to: Has insurance balance, Has patient balance, or both.
- Select a Date Range.
- Edit or Enter a Claim Note.
- Search for single Payer.
- View particular current status by Stage.
- View different Categories .
- View the status history of open claims.
- Search by a particular Provider in the practice.
- Once you have viewed your open claims by searching by various parameters, you can now take action to the follow up of your claims.
- Edit a claim (a claim can be edited only if it has been archived) by clicking the Edit button for more formation on editing a claim, please see Edit an Archived Claim.
- Transfer a Claim to the Transmit Queue for resubmission to a payer by clicking the button.
- You may manually add a Claim Status Entry to a claim when you have received a payer’s notification of the status of a claim, whether it is rejected, pending, acknowledged or finalized. Click the button.
- Other functions in this screen include:
- Fetch Reports : Click this button to send out a request to the clearinghouse to retrieve any payer reports that are available. These reports will vary depending on the clearinghouse and on the individual insurance carrier.
- Process Reports : Click this button to process any reports that have been received.
- Apply Payments : Click this button to open the patient's Payments form.
- Check Status : Click this button to send a request to the clearinghouse for the selected claim. If available, the request will come back and update the claim with a status. See Status Category for Billing tab for the complete list of status options.
If you are using Full HIPAA transactions fetching/processing reports from your clearinghouse, the claim status is reported by your clearinghouse. A clearinghouse generally has more than one level of claim status. The first level is the clearinghouse review of the claim, where it can be accepted or rejected based on basic criteria. Some clearinghouses have a second level of review, where an accepted claim can change to rejected based on more complex criteria. And finally, some clearinghouses provide a third level of review based on a response from an individual payer, where an accepted claim can be rejected or pended or even finalized for payment.
The status history provides detailed information about when a claim was sent to the queue and when it was transmitted and/or printed. Depending on your clearinghouse and your ability to process level 1 audit reports from your clearinghouse into Office Practicum, you will also be able to see whether the claim was accepted or rejected upon initial submission to your clearinghouse. To view the status history of a claim:
- Click on the Status history radio button, located directly above the Open Claims grid, to show status history.
- Click on an open claim and once it is highlighted, click on the Image: Add.jpg button to the left of the claim to view its status history.
You can manually change claim status based on additional information provided by your clearinghouse or a specified payer. To do so:
- Under the Claims + A/R sub-tab, locate the claim you'd like to update, and click to highlight it.
- Click on the Add Status button in the upper right corner of the window.
- On the status line for this claim, click on the Status Date field, and select the date from the drop-down calendar.
- Repeat the above procedure for the Status Category, Code, and/or Entity fields, entering information using the drop-down lists.
|Note: If desired, you can also make manual entries in the Payer Claim ID, Amount or Notes fields.|
- Click on the button, located in the small tool bar to the left of the status line, to save your changes.
- Click on theicon, located in the tool bar at the top of the eBill form, to make the new category status visible.
- Under the Claims + A/R sub-tab, locate the claim you'd like to transfer to the queue, and click to highlight it. You can also select multiple claims (for the same or multiple patients) by holding down the Ctrl key while making multiple selections.
|Note: To select specific claims for viewing, see How to view open claims, above.|
- Once the desired claim or claims are highlighted in blue, click the Add to Queue button or Queue Primary button located to the to of your screen. A user also has the ability to select Queue Secondary. Please not that queuing to secondary will not transmit from the claims queue. Secondary stage claims will be dropped to paper, as indicated on the e-correspondent tab of your chosen clearinghouse.
- The claim will now be waiting in the queue for re-transmission or printing to a CMS-1500.
|Note: Individual claims can also be sent back to the queue for reprocessing from patient’s account in Claims.|
The claim note can be used to document specific date of service issues (e.g., claim not on file; resent on paper or payer denied claim for invalid diagnosis, corrected diagnosis and claim back to queue).
|Note: The claim note is an internal field for accounts receivable management. This note will print on aging reports only, and not on the patient statement. The note that appears on the patient statement is the Memo field, located in the Edit Archived Claims form.|
For more information see: