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 Ins.

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

Claim Status from Clearing House*

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Claim Fix from Clearing house*

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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

Resume 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
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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
• Use Original Date:
• 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
• Set Encounter:
• Clone: clones the last entries data

*Charge Entry – Claim Entry Tab

• Save: saves current entries, selections and changes
• Cancel: cancels current selections
• New:
• Form: open 
• Orders:
  • eLab Order:
  • Cloud eRx:
  • Cloud Rx History:
• Bookmark:
• Open Patient Chart:
• Message Patient:
• Patient Info:
• Refresh from Superbill:
• Print Claim:
• Print Statement:
• Review Data:
• Remove Claim:
• Delete:
• Move Up:
• Move Down:
• ReferMD:
• Provider:
• Facility:
• Hold:
• Send Refund:
• Batch Statement:
• Add:
• Edit:
• Delete:
• Save:
• Cancel: 
• Remove:
• Card Payment:

• Add:
• Edit:
• Delete:
• Save:
• Cancel:
• Sent:
• Posted:

• Box 14 Type:
• Date:
• Box 16 Unable to work from:
• Box 15 Onset:
• To:

• Accident Type (box 10):
• Hospitalization from (box 18):
• Place:
• To:

• Box 20 Outside Lab:
• Amount:
• Box 10d:
• Box 22 Medicaid:
• Original Ref:
• Box 19:

• Hold Statement:
• Statement Note:

*Charge Entry – Superbill Tab

1. Template:
2. Encounter:
3. Provider:
4. Facility:
5. Visit Type:
6. Procedure Search:
7. Copy Last Visit:
8. Copy Other Visit:
9. Diagnosis Search:
10. Charge Slip Summary:
11. Refresh:
12. List Changes:
13. Update:
14. Recall:
15. For:
16. Auth:
17. Encounter Billed:

Batch Posting

• Deposit Date:
• Note:
• Insurance Payments:
• Patient Payments:
• Posting Code:
• Patient Chart:
• Claims:
• Ledgers:
• Acct:
• Ref#:
• DOS:
• Payment:
• Adjustment:
• Clear:
• Post:
• Provider:
• Note#:
• Sent:
• Posted:

Print Format Window

• Exit:
• Print Grid Guide:
• Export:
• Import:
• Local Printer Adjustment:

*ERA Window

• Manual Import:
• Filter:
• Reset:
• Create Batch Posting
• Append Batch Posting:
• Remove Batch Posting:
• Remove ERA:
• Download ERA:
• Print:

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