Claims

The Claims Module is presented by a plus sign icon, and is where claims for various insurance companies with exact preferences for each payer are set up. Through this module, the user can review timesheets and bulk merge claims for submission.

Claims Claims Module Permissions

Employees with the following permissions have various levels of access to the Claims module. These permissions can be enabled via the   Permissions module.

  1. Access
    • Basic access to the Claims module
  2. Claims > Create
    • Create claims from the billing view
  3. Claims > Manage Organization Labels
    • Add, edit, and remove organization claims labels
  4. Claims > Use Organization Labels
    • Add and remove organization claim labels to and from claims
  5. Settings > Manage
    • Add, edit, or delete claim insurance settings

Click here to learn about other permissions.

Billing / Claims Completing the Payor Import

New clients must complete a payor import file before beginning implementation. The purpose of this file is to ensure clients’ payors match payors in CentralReach’s database, so that claims will be sent correctly. A spreadsheet application, such as Excel, WPS Spreadsheets, or Google Sheets, will be needed in order to open and complete the payor import.

See below for a breakdown of how to complete columns A-M of the payor import:

  • Column A: The name of the insurance company
  • Column B: The name of the specific plan under the insurance company
  • Columns C- F: The insurance company’s mailing address
  • Column G: The payor’s ID with Office Ally, which indicates where claims should be sent. The ID can be located here, by conducting a search for the payor.

    • Please note, it is important that this ID is inputted correctly, so claims are submitted to the right payor. If you are unsure of the payor ID, contact the payor directly to confirm their ID.
  • Columns H-I: These columns indicate if pre-enrollment is required with the payor to submit claims or receive responses electronically. 
  • Columns J-M: These columns let CentralReach know how you are currently billing and how you want to bill in CentralReach. 

Claims The Pay-To Section in Claims

When claims are generated, the “Pay-To” section is blank by default. For an organization to have this auto-populate for all claims, please contact your CSL or open a support ticket.