Billing

Billing

Claims

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    Other Sections

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      List Unblilled Encounters

      1.  Click Billing > click Generate Claims (see reference)
      2. Specify the correct date range
      3. Find Print Option > select the Reprint Unpaid Claims option 
      4. Click Print

      Verify Patient Info

      1. Open the patient’s summary > click Patient Notes 
      2. Open the Patient Registration Form > click Exit
      3. Click Patient Profile
      4. Verify the details match the registration form

      Verify Insurance Info

      1. Open the patient’s summary > click Patient Profile
      2. Verify the details match the insurance card

      Verify Encounter, Provider, CPTs, & ICD10s

      1. Open the patient’s summary >  click Patient Notes 
      2. Open the relevant document > click Exit
      3. Click the related entry below the correct summary section (e.g. Encounter, Diagnosis, CPT, etc.)
        1. Or click the correct summary section title to open that tab in patient timeline window > find the related entry
        2. Or click the Timeline tab to open the patient timeline > find the related entry
      4. Verify the details match the patient note

      Create Superbill

      1. Open the patient’s summary > click the $ symbol next to the correct encounter to open the Claim Entry window 
      2. Click the Superbill tab  > enter the Ecounter, Diagnosis, and CPT data, as well as the amount collected and any recall or notes 

      Create New Claim

      1. Open the patient’s summary > click the $ symbol next to the correct encounter to open the Claim Entry window
      2. Click the Superbill tab > verify the Encounter, Diagnosis and CPT data > click New
      3. Verify each CPT code has a diagnosis pointer, fee and POS (default POS is 11) > click Create Claim 
      4. Click Save

      Open/Edit Existing Claim

      1. Open the patient’s summary > click the $ symbol next to the correct encounter to open the Claim Entry window (see reference)
      2. Add new data or modify the existing data
      3. Click Save

      Remove Claim

      1. Open the patient’s summary > click the $ symbol next to the correct encounter to open the Claim Entry window (see reference)
      2. Click the Remove Claim link
      3. Click Yes to confirm
      4. Click the correct entry below the encounter section
        1. Or click the encounter section title to open that tab in patient timeline window > find the relevant entry
        2. Or click the Timeline tab to open the patient timeline > find the relevant entry
      5. Uncheck the Billed box for the removed claim

      Print Individual Claim

      1. Open the patient’s summary > click the $ symbol next to the correct encounter to open the Claim Entry window (see reference)
      2. Click the Print Claim link
      3. Find Claim Form > select the correct format option > click Print

      Print Individual Statement

      1. Open the patient’s summary > click the $ symbol next to the correct encounter to open the Claim Entry window
      2. Click the Print Statement link
      3. Select the correct options from the Select Parameter window click Ok

      Sending Claims

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        Print Batch Claims

        1. Click Billing > click Generate Claims (see reference)
        2. Specify the correct date range 
        3. Find Payer > select the correct option
        4. Find Print Option > select Print Pending Claims
        5. Click Print

        Print Batch Claims by Insurance

        1. Click Billing > click Generate Claim (see reference)
        2. Specify the correct date range
        3. Find Payer > select the correct option
        4. Find Print Option > select Print Pending Claims
        5. Find InsPlan > select the correct insurance plan
        6. Click the Print button

        Reprint Batch Claims

        1. Click Billing > click Generate Claims (see reference)
        2. Specify the correct date range
        3. Find Payer > select the correct option
        4. Find Print Option > select Reprint Pending Claims
        5. Click the Print button

        Upload Batch Claims to Clearing House (OfficeAlly)

        1. Find the claim file (OfficeAlly_mmddyyyy.txt) generated by the EMR
        2. Upload the claim file to the clearing house

        Check Claims Status (ERA)

        1. Click Billing > click ERA (see reference)
        2. Expand the correct date
        3. Select the correct claim

        Posting

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          Create Batch Posting

          1. Click Batch Posting (see reference)
          2. Click New > choose either Insurance / Patient Payments
          3. Enter the patient’s account number
            1.  Or enter the claim number
          4. Verify the correct DOS (date-of-service) is shown
            1. Or find DOS > select the correct date
          5. Find Payment > enter the correct amount
          6. Find Adjustment > enter the correct amount
          7. Click the Post button
          8. Repeat steps 1 – 7 for the next payment
          9. Click Save

          Open Batch Posting

          1. Click Batch Posting (see reference)
          2. Click Open
          3. Enter the account number > specify the date range > click Search
          4. Double-click the correct batch posting to open it

          Tips

          • The system will automatically select the DOS after entering the account / claim number. It may not always be correct. (see step 4A)
          • Each posting will create a new entry in the ledger using the Payment and Adjustment values.
          • If the Adjustment box is left empty the system will automatically fill in the amount needed to balance the claim.
          • Use the tab key to move from one box to the next.

          Change Claim Format

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            Print Guide Page
            1. Click Billing > click Edit Print Forma (see reference)
            2. Select the correct form > click the Print Guide Grid button
            3. Click the Print button in the browsers print window
            Adjust Claim Format
            1. Click Billing > click Edit Print Format (see reference)
            2. Select the correct form > click Local Printer Adjustment
            3. Follow the instructions to align the claim to the form
            Fix Mapping Procedure Errors (OfficeAlly)
            1. Login to OfficeAlly
            2. Find the Rejected queue > check the reason for rejection
            3. Verify the data
              1. If the claim and submission data do match request support
              2. If the claim and submission data do not match reconcile the errors and resubmit

            Reference Guide

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              Generate Claims Window

              • Claim Form: selects claim format option
              • Payer: selects payer option
              • Test Only: sweeps claims without affecting the pending status of the claim
              • File Output: displays the files name
              • Append: adds the current output to the most recent previous output
                • Option: selects which of the previous outputs to append the current output
              • Print Option: selects the print option (e.g. Pending, Unpaid, All claims)
              • Provider: selects the provider
              • Create From: selects which date to begin the sweep
              • To: selects which date to end the sweep
              • Biller: selects the biller 
              • InsPlan: enter or search for the insurance provider
              • Show Deductible on Claim: displays the deductible on the claim
              • Hold File Output: holds the file output instead of automatically downloading it
              Ledger Tab

              • Add: creates a new ledger entry
              • Edit: edits the selected region
              • Save: saves current entries, selections and changes
              • Cancel: cancels current selections
              • Delete: deletes the selected entry
              • Search: searches the ledger’s entries
              • Print: prints the ledger
              • Preview: displays a print preview of the ledger
              • Clone: clones the last entries data
              Charge entry – Claim Entry Tab

              • Save: saves current entries, selections and changes
              • Cancel: cancels current selections
              • Form: selects a form to be opened and filled (see configuration)
              • Orders:
                • eLab Order: opens the lab order window
                • Cloud eRx: opens the eRx window
                • Cloud Rx History: displays the patient’s eRx history
              • Open Patient Chart: opens the patient’s chart
              • Message Patient: creates and opens a blank message related to the patient
              • Patient Info: opens the patient info window
              • Print Claim: downloads the claim according to the users print selection
              • Print Statement: generates a statement for printing according to the users selections
              • Remove Claim: deletes the current claim 
              • ReferMD: selects and displays the referring MD
              • Provider: selects and displays the provider
              • Facility: selects and displays the facility
              • Card Payment: opens the payment window for processing payments via Bluefin