Step by Step Work flow-Claims Manager

Claims will need to go through the Scrubbing process to check for missing data. This process will catch claims that are missing some basic information, such as insurance information, patient demographics, charge information, payer information, etc.

Pending Scrub Section

Patient accounts with payer information entered into the Insurance Demographics section of the Chart/Patient Account will automatically produce a claim when new charges are added and the Follow Up Action is set to Submit to Insurance in the New Charges tab.Those claims will be placed in the Pending section of the Claims Manager until they are Scrubbed and Submitted to the payer or clearinghouse.

1. Click on the claim line to highlight.

To select random claims, Click on a Claim and while holding down the Ctrl key, left click on select claims to highlight. To Scrub all claims in the section, click to highlight the first claim, and while holding down the Shift key, click  to highlight the last claim. This will highlight all claims listed.

2. Click the Scrub button. Claims will be moved to the Ready To Process section.

Note the Claim number 1327 in the red box. This lesson will track that claim from Pending Scrub to Submitting claim.

Insurance remittance/response will use this claim number in the Patient Account section of the EOB to identify the patient.

 

Scrub Errors

Claims will be moved to the Ready To Submit section unless the scrubber finds error(s) on a claim as shown in this screen shot. Claims with errors will be moved to the On Hold section to be edited and rebuilt. A reason for rejection will be noted in Hold Notes column.

3. Click Ok. The error dialog will continue to prompt you to click OK for each claim that has errors until all selected claims have been scrubbed.

Open Patient Account

4. Double Click on Claim line to open patient account and make edits.

Edit claim in Claims Tab

5. Double Click on Charges line item in error to open Charge Details dialog.

Edit Charge Details

Edit Charge Details

The scrub error said diagnosis was missing for procedure code 85025. Verify the correct charge was selected and add/edit needed information.

6. Click Add Code

7. Begin typing code or code Description and select from list.

8. Save edits. Close account and return to Claims Manager.

Rebuild Claim

9. Click on claim line to highlight.

10. Click the Rebuild button. Claim must be rebuilt before edits will be applied.

11. Claim will be moved to Pending section. Click Scrub.

12. Claim will be moved to Ready To Submit section.

Click Generate Electronic to select all electronic claims that are ready to submit and generate an electronic claim file to upload to clearinghouse/payer with one click.

Click Print Claims to select all paper claims that are ready to submit and print .

Click Submit Selected to select and submit only specified/highlighted claims for printing or uploading.