Billing Workflow - Clinical Documentation to Claim Creation
1. Open the SOAPnote
Open an existing SOAPnote or create a new SOAPnote.
See: Create a SOAPnote for help.
2. Document the Encounter
3. Associate Diagnosis Codes with each CPT/HCPCS Code
To associate each diagnosis with the appropriate CPT/HCPCS code:
- Click on the Related Dxs header.
- Select the related diagnoses from the SMARText Quick Access window by placing a check mark in the Selected column.
Repeat the above steps to record the Related Dxs, Modifiers and Days/Units for each CPT/HCPCS code.
4. Create the Billing Statement
Click the Create Billing Statement button.
5. Add the Task Item
A task item is created with the addition of a new billing statement. Edit the task item as desired and assign it to the appropriate staff member. Click Add to proceed.
6. Review and Post the Billing Statement
- Review the Billing Statement including the CPT/HCPCS codes, diagnosis and modifiers.
- Enter Notes, as needed, to relay information to the front office/billing staff.
- Click the Post Superbill button to electronically submit the superbill to the front office/billing staff.
7. Add Document Task for Superbill Posted
A task item will be created so the user can notify the biller that New Charges have been posted.
- The Assigned To user will default to the user that was select as the "Superbill Task User" within Provider Manager. If a "Superbill Task User" has not been set in Provider Manager, the task will default to the physician, but can be changed as needed.
- Click the Create button to add the task for the specified user.
- Once posted, a message will display to indicate that the superbill was successfully posted.
*Note: This task item can be set to be automatically sent to a designated staff member. To set this, go to Provider Manager, select the "Superbill Task User" and then check the box to indicate "Auto-Create Post Suerbill Task".
8. Open New Charges from Task List
The biller will now process the New Charges. To open the newly posted charges, double-click on the "Superbill Posted" task item located on the Task List (SOAPware > Tasks).
9. Process/Post Visit Charges and Create Claim
- Double click on the charge to review for any changes.
- To change claim level information, click on More Info and edit as needed.
- If a co-pay was taken when the patient checked in, you can manually apply that co-pay to the newly posted charges by clicking Apply Co-Pay and distributing as needed.
- If you need to take a new payment, click Add Payment.
- If the patient has an active insurance policy, the Follow-Up Action will default to Submit to Insurance. If Submit to Insurance is selected as the Follow-Up Action, a claim will be created when the visit is posted. If you do not want to create a claim, select Do Not File. Patient Responsibility from the Follow Up Action drop down.
- If there is a Primary Insurance policy for the patient, it will be listed here. The policy can be changed/switched to another policy if needed by clicking the drop down and changing.
- The route of the claim will be defaulted from the Default Electronic option that was selected in the master Insurance Company setup. If Default Electronic was checked at the Insurance Company level, electronic claim submission will default here. If Default electronic was NOT checked, the default claim submission method will be paper. However, the claim route can be changed from the default at any time.
- If there is a Secondary Insurance policy for the patient, it will be listed here. The policy can be changed/switched to another policy if needed by clicking the drop down and changing.
- To generate a secondary claim from SOAPware, change the Follow Up Action to either File Secondary Electronic or File Secondary Paper when posting the primary remit. This will place the secondary claim in the on hold section of the claims manager for you to rebuild, scrub, and send to Trizetto or paper claim.
- Post the visit to the ledger, when finalized. If a claim is generated, it will show in the patient's Claims tab, as well as in the SOAPware Claims Manager for scrubbing and further processing. Once the visit has been posted, the Post Superbill task will be marked as completed on the user's task list.