Claims Manager

Claims / Claims Manager Aetna Claims Issues Explained

 

02/24/2017 – Aetna Claims Issues

You may have received an email from CentralReach tech support regarding discrepancies of Aetna 835s (ERAs). What exactly does this mean?

It has come to our attention that when posting payments electronically in CentralReach the payment may sometimes post to the incorrect line item. For example, if both the EOB and the ERA state that $20 should be paid for a service on 6/17/16 when users click reconcile, it may post this payment to the wrong date of service of 6/18/16. Consider the example below.

Normally, when a biller clicks on Reconcile checked, each amount in the Paid column would apply the correct payment on that date of service for that code. From the screenshot below, this means that $36.80 would be applied to billing entry from the date of service on June 7th with the service code 368T, another $36.80 applied to the entry from June 2nd with 0364T, etc.

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However, users may find that if they click on Reconcile Checked without individually auditing each timesheet, the system may be applying the payments to the wrong date of service and/or code. So clicking on the first entry below from June 7th with the service code of 365T:

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…may take them to the billing entry from June 2nd with service code 365T as shown below:

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When CentralReach sends electronic claims to Aetna via Office Ally, each billing entry gets its own unique code; for example, an entry from 6/17 may have the code 123456 with a charge of $20, and an entry from 6/18 may have the code 654321 with a charge of $50. When Aetna sends these entries back into CentralReach, sometimes, the codes may come back scrambled. So, instead of coming back as:

Payment to 123456: 20.00 for 6/17
Payment to 654321: 50.00 for 6/18

They may be coming back as:

Payment to 654321: 20.00 for 6/17
Payment to 123456: 50.00 for 6/18

To prevent discrepancies in the reconciliation of Aetna claims, we recommend that billers audit each line entry by clicking on each one from the Reconciliation screen, then applying the payments manually as if they were paper EOBS, rather than clicking Reconcile checked to prevent payments being posted to the incorrect billing entries. Please note that this is not happening with every Aetna ERAs, so if users click on each entry from the Reconciliation page and are taken to the correct billing entry, they can still reconcile electronically.

We are currently working with Aetna to resolve their EDI compliance discrepancies. If you have any questions, please open a support ticket and one of our agents will advise further.

The second scenario involves Aetna splitting the payments and claim lines and creating multiple payments that then record multiple times.

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In the above scenario, there was only one line submitted for 9/1, but Aetna internally split the claim, this can be seen here, as well as, on the ERA, txt file.

 

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9/02/15 – New Features to Help Migrate ICD-9 to ICD-10

CentralReach is dedicated to helping you effectively manage your practice in an ever-changing healthcare industry. That’s why we are releasing additional features to help you prepare for a significant change in ICD coding.

ICD-10, the tenth revision of the World Health Organization’s International Classification of Diseases (ICD) coding system, is set to replace ICD-9 in all U.S. hospital and clinical healthcare settings on October 1, 2015. Any entity covered by HIPAA will need to comply with ICD-10 in order to obtain reimbursement for care, including clearinghouses and billing services.

To help you prepare for ICD-10 changes, CentralReach is adding new features to our Contacts, Authorizations, Billing, Timesheets, and Claims Manager modules that make editing diagnosis codes even easier. Each diagnosis field within these modules can be changed to ICD-10 selections by searching for it. Detailed information about this updated functionality can be found in our help section over the new few days.

Please be sure you are in contact with your payers to discuss how ICD-10 impacts your claims and reimbursement processes; each insurance company has unique strategies and nuances for managing this transition.

Thank you for your support as we work through these industry changes together.

Claims / Claims Manager Finding Claims That Have Not Been Submitted

To identify claims generated but not yet submitted to a clearinghouse:

  1. Navigate to the Claims Module  and select Claims Manager.
  2. Click the Inbox button on the top of the page .
  3. The list of claims that have not been submitted to the gateway will be displayed, along with the list of claims processed manually.

If a 1500 form was exported to process the claim manually, click the link under the Exported column to retrieve the claim information.

Claims / Claims Manager How do I accept electronic payments?

CentralReach offers you the ability to receive responses (payments/rejections) from insurance companies electronically via Office Ally. To access your electronic responses navigate to your Claims Manager>Click the “Responses” tab. To access only payments, click the “Payments” tab.

From this page, click the “+” directly to the left of the claim id to expand the payment information. Once the information has expanded, click the eye icon under “Actions” to open the payment reconciliation page. From here you can reconcile/post the electronic payments. Once the payments have been posted they will be reflected in the billing entries associated with them.

Claims / Claims Manager How do I automatically combine service lines on a claim?

When processing a claim within Claims Manager our system will combine lines of service with the same date and service code.  The nice part is that this does not alter the original timesheets or billing entries thus ensuring an accurate history for payroll and billing purposes.  To combine these entries start by generating a claim.  In billing, select the the entries you wish to submit and click “bulk-merge claims” from the ‘actions’ drop-down menu.

In the next screen you will see two tabs at the top. You will be defaulted into the Separated view tab. While in this tab you will see all the billing entries that were selected to be merged onto the claim.

 

Click on the other tab, “Combined view” and you will see all entries with the same billing code and date of service combined into a single service line. Click on the blue +/- next to the service line to see the individual lines that were combined. By clicking on the two arrows next to each line of service you are able to combine or un-combine service lines.

When you are finished combining and/or un-combining as required by the insurance company, you then click on the blue Merge/Move to inbox button and the service lines will be combined in the Services tab on the claim.

Claims / Claims Manager How do I bring another office location’s address to a claim?

In order to bring over information such as NPI, tax ID, or address of another office location, please create a generic contact in your Contacts module as shown here.

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Then, just as you would set up an employee’s claim settings, navigate to this office location from your Contacts list, and click Profile > Settings > Claim Settings.

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Fill out “first” and “last” name (e.g. “Miami Office), Organization name, enter NPI /Tax ID, along with address and any other relevant information that you want to bring to a claim. When done click Save Claim Settings.

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You will now be able to bring this office location into your claims.

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Claims / Claims Manager How do I bulk merge claims?

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.

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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

Claims / Claims Manager How do I bulk merge my claims for TriCare?

For the general process of Bulk merging claims, please see this article on the Bulk-merge process.

This article will discuss the particular nuance for TriCare submission within CentralReach’s, Bulk-merge process.

Backstory: as you know, if you are here TriCare is a little different regarding how it requires submission for claims electronically. These differences can vary based on region as well and also via providers. If you typically submit via mytricare.com, this process in CR will make a little more sense. This is not the answer to every possible scenario, but it will definitely help with ABA claims and RBT submission in particular.

There is one main thing you will need set up prior to doing claims, and that is to input the TriCare ID number for every RBT you have registered with TriCare. The ID number is often the staff’s SSN, but it can vary. If you use NPI numbers, these are even easier, but regardless, you will need whatever number/alphanumeric TriCare has on file for your RBT before you proceed, to be input into the system, attached to their contact profile.

Once you have the TriCare ID number you will goto each individual staff an enter it under, Edit contact, Claim settings. In this section you will enter the First Name, Last Name, State, and then way at the bottom you will select the Custom identifier: ‘G2 – Provider Commercial Number’.

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With that entered we are ready to generate claims.

Methodology: just like when submitting on mytricare.com, you will need to submit each staff with each client, individually, i.e. just like when you login to do an ‘xpress claim’, you select the office, then staff, then client, and then the individual codes etc. It is just like that here. You will have to generate the individual claims with the exact same methodology. If you have 2 RBTs with one client, the claims will need to be generated individually for each staff.

That said. The next steps assume you have performed any audit/scrubbing to your billing data as normal.

We will use the following data for our example.

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For our claims we will need to submit 2 individual claims. 1 for Bob and Monica, and 1 for Beth and Monica. To do so, select the individual you want to start with. We will do Bob first. Select the 4 lines of data with Bob and then, Actions, Bulk-merge.

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We examine this as normal. All the columns look good. The one change we need to make is to the Provider Supplier column. This is the data for box 31, signature box. We want this column of data to be the same as the Provider column. Note: remember the Provider column is the actual person who performed the appointment, and in this case, it is also the person we want to ‘sign’ the claim. In this case for the Provider Supplier column, we will click on the little trashcan icon to remove the data from that column to look like this:

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Now that we have emptied that column, we will Merge/Move to inbox. Once we get there we should have 3 errors. They are being triggered by the Provider Supplier data being ’empty’.

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Click on the edit pencil to open the claim in the editor. Now we can see the error are in the Provider/Supplier area by the 3.

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Navigate to the Provider/Supplier section.

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Now in the Last/Organization Name box, start typing in Bob’s name, when you see it in the list, select it. And it should now drop in as shown, notice the ‘TcareID’ set up as the G2 identifier at the bottom.

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Almost there. On this screen we need to change the ‘ID Type’ box, to say ‘Choose’. The reason for this, is because if it says XX-NPI or something else the system will not go down to grab the G2 identifier.

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Now save the claim and return to the Claim Manager Inbox. When you get there you should now generally show the claim to have 1 or 2 errors depending on your settings. This is normal, and one of the couple instances where you will submit the claims with errors from our system. The errors are due to the system looking for an NPI and not finding one. Yes, you can create settings to turn off this error and if TriCare is your only insurance we can talk about that, but in general, do not adjust your settings, you want those error catches turned on. This is what the claim will look like when submitted:

 

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As you can see the G2 number populates in 24j, and provides the 1:1 correlation between the signature box, 31, and the line item identifier in 24j. Note: this is paper and in 31, the G2 is not visible, when you send this claim electronically there are hundreds of other fields that transmit, and one of them is that the name in 31, with the G2 identifier as well.

Notes: then go back and do the same thing for your other RBT’s. If you additionally need to add the short time stamp notes, with the claims, those go in box 19. It is accessed from the claims editor under Claims, Details.

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Just as on TriCare’s system, there is a similar character limit imposed here of ~80 characters. If your note is too long you will get an “!” warning. In this case you will need to break the claim into smaller pieces.

 

UPDATE: 02/15/2016

New feature was added to get time into the claims, it is in BETA, and as we get more feed back we will pass that on as well.

In a further effort to make TriCare claims easier, our system can now add times to the claims automatically. The times pulled are from the timesheets in the system. To use this feature, just check the box during the bulk-merge process. (The screen shots here will utilize the same dates for consistency)

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The timesheet times then get added on the individual lines notes section.

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Note: if the time is split the multiple times will appear as well. TriCare states they will train their staff to read time here, it should be a game changer for this part of the claims process, if this works.

As you can see on paper, it adds them there as well.

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Recommendations if you want to try it. Pick one or two clients and a date range to test it with.

See what happens. Let us know.

 

We often get asked where the time savings is with these claims, because it is still labor intensive. The savings is in not having to transcribe every line item for every claim, as well as, if you get the 835/ERA files to come back electronically, the semi-automatic reconciliation feature built into CentralReach is a game changer for the AR processing.

Claims / Claims Manager How do I create and apply labels in Claims Manager?

You can create and apply customized claim labels to better manage your claims. To create claim labels, first navigate to your Claims Manager  [fac_icon icon=”plus-square” color=”#0a0a0a”]

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There are two ways to create a claim label. The first is to click on a label icon and then the gear icon.

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The second way is to pull up the sidebar menu by clicking on the funnel icon to the left, then clicking on the gear icon next to My Claims Labels.

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From the pop-up, select Add new label from the drop-down. Type the name of your label, add an optional parent label to house it within a “folder,” of labels, and select an optional color scheme. Some ideas for label names are: Claim not billed, Rework claim, Claim denied, Claim requires additional data, etc. When finished, click Create Label.

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To apply the label to an individual claim, click on the label icon and type in the name of the label you wish to add. Then select it from the drop down menu. The label will be applied to the claim and you can now use the label in the search field.

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You can also bulk apply/remove labels by checking the boxes next to them to the left, and clicking on Label Selected.

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Last Updated: 4/3/2017

Claims / Claims Manager How do I edit Box 19 on 1500 form?

To edit box 19 on the 1500 claims form, navigate to your Claims module and select Claims manager from the drop-down menu.

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Click on the pencil icon associated with the claim where you need to edit box 19.

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Click on the Claims Tab and enter any necessary box 19 information in the provided field.

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When finished, click on the Save Claim button.

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Claims / Claims Manager How do I enter the service address in Box 32 of HCFA-1500 form?

The insurance company Tricare has recently implemented new changes, causing the insurance’s copay amount to be based off of the service location’s zip code, and the providers are now required to enter their service address in box 32. As such, CentralReach has implemented a feature that will allow the users to enter the service address into the timesheet and pull it to the claims.

In order to enter the service address in the Box 32 of HCFA-1500, the clients’ authorizations will first need to be set up to use service location. As such, navigate to the clients’ authorization files and click to edit their authorization codes. If you would like to learn about how to set up the authorizations first, then please click on this link. Once you click to edit the authorization, a pop-up will appear and you should be able to see the Use Service Location field. SL1

 

Make sure that this box is checked when setting up a new authorization or editing the existing authorization and click on Save to save the setting. After that, create a  timesheet and make sure that a proper service address is selected in the timesheet. If you do not see the option to select the service address when creating the timesheet, then you must first enable the function to select the service address, as explained here.

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Once the service address has been selected, save the timesheet and generate a claim from the timesheet. If you have not yet learned how to create a timesheet, please click on this link. If you have not yet learned how to generate a claim, please click on this link. When generating a claim, you will be given a choice to force service location, in case you had not enabled the client’s authorization to use service location previously.

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However, if this box is not checked and the client’s authorization is not set up to use service location, the service address will not pull to the claim. In this case,  the system will will pick the billing provider info and pull to the claim. If neither of them are set up, the client’s HCFA-1500 will be generated with a blank Box 32.

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As such, make sure to either enable the client’s authorization to use the service location or check the box to force service location if you have not enabled the client’s authorization to use service location.

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If done so correctly, the client’s HCFA-1500 will be generated with correct service address.

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Note: If you bulk generate a claim for two entries with two different locations and Force service locations, the system will split the claims in two.

Claims / Claims Manager How do I find my original reference number when resubmitting my claim?

When re-submitting a claim, the original reference number of the claim may be required by the gateway. In this case, the Original Reference Number, or also called Payor Claim Control Number, is assigned by the payer and the only way to locate it is through the payor. In the Claims Manager, you can find each claim’s original reference number by opening the desired claim, selecting the Claim tab in the sub-menu, then selecting Details below it.

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However, if the claim had been exported to the computer, then there are other methods of finding the reference number. If the claim was exported as a .pdf file, then the reference number can simply be found in the Original Ref. No. box next to the Box 22.

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If the claim was exported as a data dump, then the number will have to be searched in a different method. The term Original Reference Number is changed to PayerClaimControlNumber in the data dump.

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Claims / Claims Manager How do I manually combine service lines on a claim?

You can alter claims and combine dates of service using the Claims Manager.  The nice part is that you will not alter your timesheets or billing entries by altering the claim itself.  This ensures an accurate history for payroll and billing purposes.  For example, if you have a client who has two or more services provided on a single date and would like to combine those entries into one, start by generating claims.  In billing, select the the entries you wish to submit and click “bulk-merge claims” from the ‘actions’ drop-down menu.

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Next, a pop up box stating “Claims generation complete” will appear. Please follow the prompt and click the Claims Manager link.

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In the ‘actions’ column on the far right, click the pencil icon to edit your claim. Please note, you will only have to edit the one claim as both timesheet entries are contained within as a result of the bulk generator.

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Navigate to and select the ‘services’ tab located along the top of the page.

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Next, click ‘add a new service line’ link highlighted in blue.  Select add a new service line and provide the claim information, i.e. combined hours and rendering provider.  Once complete you can delete the other entries by clicking on the trash can icon at the far right.  An alternative option is editing one actual line entries and deleting the other(s).

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enter rendering provider

 

 

Claims / Claims Manager How do I manually edit the provider/supplier within a claim?

Start off by navigating to your claims manager. You can access your claims manager by clicking on the icon with the + sign on it (located to the right of the $ icon). Once you’re inside of your claims manager, locate the claim that you would like to edit and click the edit icon.

After clicking the edit icon, you will be brought to this screen:

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From this page you will need to navigate to the “Provider/Supplier” tab. From this tab you can manually input whichever employee or organization you would like listed as the provider/supplier. This information listed in the “Last/Organization“, First Name“, and “Provider Signature“boxes will appear in box 33 of the HCFA 1500 form. Keep in mind if you have no signature on file for a given provider they can manually sign the form after it is printed.

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Claims / Claims Manager How do I migrate from ICD-9 to ICD-10

The diagnosis (DX) codes will be available and appear in different places throughout CentralReach for users to enter or edit, just as before. The big change is that everywhere users can add/change one, there are limits. Since ICD-9 and ICD-10 are not interchangeable, this is not an automatic process. Additionally, only one code set can be used on a contact, authorization, timesheet, during bulk merge, or in the claims editor. It will be up to every organization (ORG) as to how/where/when to update them, as well as their accuracy. This article will outline the basic functionality and where the various interaction points are located. Please clear your browser(s) cache if you encounter any difficulty with the following changes.

As stated above, users can only use one code set or the other; therefore, once a code set is selected, the system will automatically only allow DX codes from the same ICD set be added to an entry. For example, if you select F840, you can only have that DX code (and others from ICD-10); not have the DX code 29900, as well. If there are mixed timesheets during the bulk-merge process, the system will flag this and users will be required to pick one ICD code set or the other, to maintain consistency on the claim (this is shown below).

Lastly, when billing is being generated or if back billing, keep in mind that the dates of service and their relation to 10/01/2015 will dictate which ICD set will appear on claims. Please adjust and/or split the dates of service for your claims accordingly.

The main places DX codes are located have not changed:

1. Contact > Edit > Claim settings – this location can set the default for all timesheet entries.

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As noted in the blue box, once one or the other is selected, users can only add codes from the same set.

Example of ICD-9 usage:

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Example of ICD-10 usage:

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One set or the other. That is the theme throughout CR.

2. Authorization > Individual authorized service code – just as before, users can specify the DX code here, and this would override the default DX code from the client’s Claim settings shown above. Note: if a default is added at the contact’s Claim Settings as ICD-10, and you would like to also specify the DX code on the authorized service lines, please make sure that there are no differing ICD-9 code set up there; otherwise the two DX codes will be ‘fighting’ one another, possibly resulting in mixed timesheets.

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As stated before, if a DX is specified in the line-level authorization, users are locked to that set throughout the authorized code.

3. Timesheet – Billing or Timesheets screen, Actions > Edit timesheet – as always, clicking on the blue Show claim info button will reveal the DX codes as well as other claim settings for that individual timesheet.

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4. Billing > Actions > Bulk merge claims – the ability to edit the DX will show up here, as well as a new feature that allows users to edit/add/remove DX codes. Note: For the example below, two entries were saved with differing code sets to demonstrate the potential error. The two different timesheets were selected to bulk-merge.

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As mentioned above, users will have to determine which version to use. Note: while you can add an ICD-9 code in addition here, you cannot merge the claim until one code version is the only ICD code set on the claims.

Ex.: ICD-9:

Screen Shot 2015-09-02 at 4.33.06 PM

Ex.: ICD-10:

Screen Shot 2015-09-02 at 4.33.30 PM

Once one version is selected, you can complete the merge process.

5. Claims editor: Once the claim is in the Claims manager inbox, users can additionally edit the DX code there just as before, with the same, one code set or the other.

Screen Shot 2015-09-02 at 5.02.36 PM

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Claims / Claims Manager How do I print only text on a pre-loaded CMS 1500 form?

If you already have the blank CMS 1500 forms and simply wish to fill in the text, first, navigate to your Claims Manager.

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Export the desired claims by selecting the check-box > Actions > Export/Download.

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Select CMS 1500 > Export.

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Download the forms from your claims export progress window.

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The next page will display the form from the browser’s PDF viewer, but most browsers are not capable of supporting more flexible printing options, so you will have to download this into your computer first. To do so, click download, and save it to your computer.

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Open the file from your Download folder with Adobe Reader, and select Save and Print Options > Print Text Only, which will allow you to print only the text in black into your pre-loaded 1500 forms.

2017-02-23 17_01_45-3368002d80334e848d2fd14b8cd7c222.pdf - Adobe Reader

Last Updated: 2/23/2017

Claims / Claims Manager How do I split a claim by providers?

This article will outline how to split claims by different providers. This is primarily designed for Tricare submitters, but it can also be very handy for multidisciplinary providers such as SLP/OT/PT.

To begin, select your billing entries as usual. Then select Actions > Bulk merge claims.

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You will get the usual screen, with one claim, for the one client.

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Now click the Split on Providers checkbox. You will notice that the claim will split into one claim per client and per provider, so in this case, three claims.

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If any changes need to be made on this bulk-merge screen, make them, and click Start claims generation.

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Submit via regular channels.

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Note: while this feature is initially designed for one client at a time, you could do multiple clients and staff; just be aware that it may take a little longer at each step.

Last Updated: 3/29/2017

Claims / Claims Manager How do I submit a secondary insurance claims submission?

This article will help you to populate the CentralReach claims with the necessary information to submit the paper HCFA 1500 form to secondary insurance.

For each line you want to bill to the secondary insurance switch the payer from primary to secondary by clicking on the payer box that is underlined by the dashed line.

Selecting 2nd

Once selected, click the red checkmark to save.

2nd selected

Now since that line, or multiple if you wanted, is changed, click Actions, Bulk Merge claims, put any changes here and then select Merge/move to inbox as normal. As you can see we now have the claim ready to send as if the secondary payor is the primary.

claim wi 2nd as prmary

Select the pencil icon to edit the claim. Now on the COB tab select the primary as the ‘other insured’.

This will pull all of the info automatically and you can add or change any missing pieces. *Note – the way the system was mapped you need to make sure the Last name and first name are what you expect, as well as make sure the ‘Policy/Group/FECA number’ is the primary insurance ID number only on this page.

Now you will want to fill out box 29 with what the primary/other insurance paid. To do so, navigate to the ‘Claim’ tab.

Once you populate this box with the amount paid, click ‘Save Claim’, and it is ready to print. Now select the claim and Export/download the claim as a 1500 form and box 1 should have all the secondary information and box 9 will have the primary with box 11d checked as well, and lastly box 29 will show what you already received. Note: if you received 0.00, that is an amount, don’t forget to enter it in, if that is the case.

Screen Shot 2015-11-04 at 8.31.04 AM

Final note: once you change the payer information on the billing screen, remember that your receivables will now reflect that money being owed by the secondary payer, and it will no longer show up as being owed by the primary insurance company.

 

Updated 4/3/2017

Claims / Claims Manager How do I submit corrected or replacement and voided claims?

This article assumes that you know how to bulk merge claims and will walk you through how to complete a Corrected/Replacement claim or Void a claim with a carrier. NOTE: Make sure you fix the timesheet(s) you are going to replace before you regenerate the claim. Please review both options as well. Loosely defined: Option 1, no ERA; Option 2, yes ERA. Regardless, you can do Option 1, always.

Additionally: a key thing to remember, before you send a corrected/voided claim, is to make sure you have the Claim ID number from the payer you submitted to in the first place. Without the internal identifier from a payer, the payer will have no idea what you are trying to correct or void in the first place. If you need to send a corrected/void a claim, you cannot do so until the claim has, at minimum, entered the payer’s system and been assigned a claim number with them, that you are able to retrieve.

Lastly: remember, if you are replacing a claim, you want to replace all of the line items on the claim, i.e. if your original claim sent 10 line items to a carrier, and you need to fix 1 line from that original claim, you have to send all the other 9 lines as they originally appeared on the claim, fixing the 10th item you are trying to correct. The reason for this, is because when a carrier corrects a claim, the first thing they do is completely ‘void’ the original. Then they completely reprocess the claim, with all of the items you are resubmitting, including any corrected items. Make sure your data is complete, so you don’t short yourself on accident.

That said, let’s get fixing.

There are 2 ways to do this: Option 1 is to edit the timesheet data, and then bulk merge the claim from scratch; Option 2 ( down below) can be used IF you received an ERA for the claim in question.

Option 1

The first step is to regenerate the claim you want to replace, fix the timesheet info first, then regenerate the claim. Once the claim is regenerated and in the claims manager inbox, click the edit pencil to open the claim in the claim editor.

Screen Shot 2015-08-14 at 12.09.50 AMOnce the editor opens, click on the ‘Claim’ tab.

Screen Shot 2015-08-14 at 12.11.19 AMAs you can see the claim has the Submission Reason, ‘1 – Original’. All claims have this when they enter the claims manager inbox by default (unless Option 2 is used below).

We will adjust this, as needed, and then input the payer’s ‘Original Reference No:’ as well.

Screen Shot 2015-08-14 at 12.14.11 AMChoose the submission reason based on your intent. Add in the payer’s reference number.

Here is what appears in box 22 now, on a HCFA-1500.

Screen Shot 2015-08-14 at 12.19.58 AM

Once completed, save the claim and submit via your regular channels.

 

Option 2

If you have an ERA with the claim you need to correct, you can do so right from the ERA screen.

Once you click this button, it will take you back to the bulk merge screen, and you can generate the claim again as needed. The power tune here is that when you do it this way, the Claim will generate as “7 – Replacement”.

If needed, don’t forget to edit any entries that might need updating. Then submit thru regular channels.

 

Updated 06/29/17 AS

 

 

Billing / Billing / Filters / Claims / Claims / Claims Manager / Files How to Access Claim Export File(s)

To view and access claim paper export file(s):

  1. Navigate to the Billing Module  and select Billing.
  2. Search for the billing entry.
  3. Click the Settings Cog icon on the right hand-side of the billing entry.
    1. If the claim was just generated:
      • Select X Claims Generated (view claims) in the drop-down menu.
      • The claim page will open with the claim details.
      • Click X times  under the Export column
    2.  If the claim was generated more than 15 minutes ago:
      • Select X Claims Exported (view files) in the drop-down menu.

5. The claim export files page will open within the Files Module  displaying the claim file(s) export(s) available for the claim.

6. Click the file you with to view or download under the FileName column.

7. Click the  Download File button, to download the file, or Preview to review the file details.

 

Claims / Claims Manager Include times for all claims

UPDATE: 3/28/17

 

In a further effort to make TriCare claims easier (although this can be used for any claims, it was primarily implemented for TriCare), our system can add times to the claims automatically. The times pulled are from the timesheets in the system. To use this feature, just check the box during the bulk-merge process. (The screen shots here will utilize the same dates for consistency, pulled from longer article about RBT submissions to TriCare)

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The timesheet times then get added on the individual lines notes section.

Screen Shot 2016-02-29 at 10.43.59 AM

Note: if the time is split the multiple times will appear as well.

As you can see on paper, it adds them there as well.

Screen Shot 2016-02-29 at 10.48.39 AM

Claims / Claims Manager Matching Fields from Claims with 837p and Hcfa-1500 Forms

The loops and segments of the 837P are built into the claims module so when you’re analyzing the HCFA-1500 claims in the claims module, you can see how each box of the HCFA-1500 form will translate to in 837P. In order to see the loops and segments of 837P:

  1. Navigate to Claims  then Claims Manager.
  2. In the Claims module, find a generated claim and click on the Edit  icon.

In the claim editor, under the Providers tab, you will see that there are fields with dotted underlines. These fields pertain to areas or boxes of the HCFA-1500 insurance form. Clicking on the names any of these fields  will show you which box number of the HCFA-1500 the information belongs to and what that box translates to on 837P.

Clicking on Add will allow you to see the client’s default claims settings. You can also change those defaults from here.

Claims / Claims Manager Unable to load payer for gateway

When sending claims through the gateway, there may be instances when you encounter the following error:

export error

If you receive this error while trying to send claims through the gateway, this is typically because the insurance company’s payer ID is missing from a client’s insurance information and/or no plan has been selected. You can verify that this information is missing by clicking on the payer listed on the claim you are trying to export. If the information required is missing, it will reflect so in a pop up box.

export error reason

If you would like one of our specialists to add a payer ID to your account, do not hesitate to open a support ticket. Please be sure to provide us with the appropriate information which can be found here.

Claims / Claims Manager Verify That Claims Are Reaching the Clearinghouse

To verify a claim has been submitted via a gateway:

  1. Navigate to the Claims Module  and select Claims Manager.
  2. Click on the Sent button on the top of the page to view the claims being processed via the gateway. If a claim is in the sent folder for more than 48 hours, further review the claim as this is an indicator that the claim was not successfully sent.
  3. Click the Responses button on the top of the page to view all the claim responses.

 

Claims / Claims Manager Why are there “Generate this claim” and “Start Claims Generation” buttons?

When generating claims for multiple clients in the billing page, if you expand each client’s list of service lines, you will see that two different buttons will populate: Generate this claim and Start claim generation.

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The Generate this claim button will allow for a single client’s claim to be generated among the selected clients while the Start claims generation button will generate claims for all of the selected clients. As such, if you have selected multiple clients but only wish to generate a single client’s claim, use the Generate this claim button. If you would like to generate claims for all of the clients on that page, use the Start claims generation button. If you would like to learn how to generate a claim, please refer to this help article.