This help article will walk you thru how to generate claims in CentralReach. It assumes that you have performed any type of auditing/scrubbing prior to this stage and that at this point you are ready to submit claims.
Navigate to the billing screen and select the items you want to place on a claim.
Once you select the items, then select Actions, Bulk-merge claims.
After you click this button, you will be brought to the first stage, where your claims will be separated by client, for you to visually review a few of the main fields.
On this screen you can review for a few things. Additionally, all of these fields come over directly from each individual time sheet. You can additionally edit them on the timesheet to fine tune anything. The fields visible here are as follows:
Diagnosis code: if it is not here you can set it at either the client contact, Edit Contact, Claim Settings. Or at the individual Authorization.
Date: this is the Date of Service. It is not adjustable, it comes directly from the timesheet.
Service: it is not adjustable here, if you need to make a change you will have to back out of this screen and edit the individual time sheet.
Pointer: if it is missing, add it here, this is editable. Note: if there is no DX code(s), there will be no pointer, because the pointer has nothing to point to for reference.
Provider: this is always the person who actually performed the appointment. This also correlates to box 24j on the claims form and may or may not be the person you want in box 24j. This column is adjustable here, which we will talk about shortly.
Payor: this is the payor associated with this service line. If incorrect or missing you can back out to the billing screen and adjust it on time sheet.
Location: the information that populates to box 32, Facility. It can be adjusted on the timesheet.
Billing: the information for box 33, Billing, this is generally ‘where do the checks need to be sent’ and is also the information used to populate the EIN on the claim. Note: unless you have multiple offices or tax id’s/NPI’s the info for Location and Billing are generally the same.
Referer: this is for referring physician, box 17.
Provider/Supplier: the information for box 31, Rendering. It can be adjusted on the timesheet.
The columns for Payor, Location, Billing, Referrer, and Provider Supplier, all have to have the same information in them, otherwise the system will not let you proceed. The column for provider is the one column that is currently adjustable here. Click on the ‘magnifying glass’ icon next to Provider, and you can enter a different name.
Note: if you try to add someone and their name does not appear, it means that that employee has no Claim settings in their respective contact information. Goto the staff, Edit Contact, Claim Settings, enter their info as needed.
The reason that provider is editable here is because, generally when you submit, you want box 31, and the NPI, etc. to match the info you are sending in box 24 j, the line item NPI, etc. To do so, you need to adjust Provider here. This might not be the case for your submission, but if it is, this is the easiest place to edit it. When you change the name in that column, the system only applies the change to the claim form and the system will not change the schedule nor the payroll information.
Now that you have all the columns set up for you claim(s). We want to make you aware of one final choice. ‘Separated View’ vs ‘Combined View’.
When you initially start the bulk merge process the time sheets will come over in Separated View, where every time sheet is an individual line on a claim form. If this is how you want to submit you can skip ahead.
Generally, anytime there is a same date of service and an identical code, you will want to combine those line items into one line, this way the insurance carrier does not flag them as duplicates.
After you correct any of the column errors you might have, we recommend clicking on ‘Combined View’. When you do so any line items that are the same date and same code will be combined, just for the claim, into one line, with the units and dollars summated and appearing on one line of the claim.
Note: if you use any modifiers to delineate differences between unique services, etc., uncheck the ‘Combine modifiers’ box and this will separate the respective lines as needed.
Now that the first round of scrubbing is complete, on the bottom right, click the ‘Merge/Move to inbox’ button.
When you do this the claim will be created and you can navigate to the Claims Manager inbox to view it, edit it, export it as a paper claim, or send it to your electronic gateway, etc.
Now navigate to Claims manager. Here the system will scrub the claim further looking for data in all of the boxes, per your individual Org settings.
When you arrive, you will be in the inbox and the claim(s) you just generated will be there as well. Ideally when we get here we want no errors. But, if you have any, don’t despair. In this module the claims data is being scrubbed even further. We always recommend using the error messages to clean up claim, as well as, your database.
If you have no errors you can skip toward the end. If you do, like this claim, simply click the edit pencil on the far right and the claim will open in the claim editor and point you to the error(s) the system found.
The 10 errors we have are distributed thru different sections of the claim. If you click on each header, the item(s) to fix will be highlighted there. Fix them on the claim, save the data, and then you can submit.
Note: when fixing things here, go back to the respective area in your CR database and update the items there as well, that way within a week or 2 you can start getting errorless claims every time.
Now that the claim has no errors, we can submit.
To do so select the claim and then the ‘Actions’ button will appear, and click on it.
The same file you have just created can be exported, sent to gateway, or both.
Export/Download: this will allow you to export a data file or a CMS 1500 form. If you do the latter it will be overlaid on a 1500 form for mailing or faxing. Note: if your claim is over 6 lines for submission, when you select 1500 form it will split the claim data onto as many forms as necessary. If you are sending to gateway, electronically, the data is all ‘one’ claim and will be grouped together as such.
Send to gateway: if you are set up with a clearing house we support, you can electronically submit claims via the gateway.
Final note: We really do recommend using a gateway. Not only does it speed claims submission, it speeds payment and responses too. The final and best part, if you also receive the 835/ERA files it can really change/simpify the AR reconciliation process of all of the individual billing entries.
Last Update: 4/5/2017