Billing

Claims
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    List Unbilled 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 & ICD10

    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 (see reference) > 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 (see reference) 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 Claim 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 (Office Ally)

          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
            Advanced Configuration
            Configure Billing Information
            1. Click Settings System Configurations > expand Billing > click Configuration
            2. Enter the necessary billing information (e.g. PracticeName, PracticeAddress, CheckRT, ChechAcct, etc.)
            3. Click the Save button

            Configure Superbill Templates
            1. Click Settings System Configurations > expand PatientChart > click Superbill
            2. Click the add button to add items to the Superbill template
            3. Click the Save button

            • Name: Use the following naming schemes:
              • For procedure (CPT) codes use ‘template-name.cpt.section-name’
              • For diagnosis (ICD) codes ‘template-name.dx.section-name’
            • Code: Search for the correct procedure or diagnosis codes
              • Or enter them manually