General Workflow: Claims Manager

Billing -> Claims Manager

An Insurance Claim cannot be created unless insurance information has been entered in Patient Account Insurance Demographics tab.

Open Claims Manager

 To open the Claims Manager, click the Billing menu, then select Claims Manager.

Paper claims are identified by the Icon in the first column. Electronic claims are blank.

  1. When a charge is posted to the Ledger from the New Charges tab, an insurance claim is created and inserted into the Pending scrub section of the Claims Manager.
  2. Claims are scrubbed and placed in the Ready to Submit section.
  3. If the claim rejects for scrub errors, the claim will be placed in the On Hold section with a reason for rejection, and will need to be corrected.
  4. After a claim is edited/corrected, it must be rebuilt to apply the changes, and scrubbed again. If a claim continues to reject when Scrubbed, repeat until the claim is error free and moved to the Ready to Submit section.
  5. When the Claims are Ready to Submit, they can be generated and uploaded electronically, or printed on a CMS 1500 form.

Select a single claim by clicking the claim to highlight. To select multiple claims, click on a claim and while holding down the Ctrl key, left click on other claims to highlight. To select all claims in a section, click on the first claim to highlight and while holding down the Shift key, click on the last claim to highlight all claims selected.

For details on setting up print options, please see Paper Claim Options.

 

Column Headers

Sort Columns in each section by clicking on the column header, if needed

  • Date of Service: Date of service/visit.
  • Claim: Claim number used for identification and tracking. This number is automatically assigned when the claim is created.
  • Physician: Performing Provider.
  • Patient: Patient name.
  • Primary: Identifies patients Primary Payer.
  • PRT: Primary Payer Routing (Paper claim or Electronically sent).
  • Secondary: Identifies patients Secondary Payer.
  • SRT: Secondary Payer Routing (Paper claim or Electronically sent).
  • Amount: Total amount of claim.
  • File With: Filing claim with (Primary or Secondary).
  • Submission: Indicates to Payer if the claim is Original claim, Corrected claim, Replacement claim or a Voided claim.
  • Status: Status of claim (On Hold, Pending Scrub or Ready to Submit).
  • Hold Notes: Hold notes gives a short description of rejection reason. This note will automatically generate if basic claim info is missing in the Scrub process. It can also be typed by clicking in the grid if the claim is manually placed on hold by user.
  • Claim Notes: Claim notes are automatically added when a claim is set to Refile, has been Rebuilt, etc.  It can also be typed by clicking in the grid if needed.  

Hold notes and Claim notes are for user reference only. Notes are not included on claims