Claims not Combining
Claims will not combine if line items have different service codes, dates, or locations. In an authorization, the “Use Service Location” toggle overrides the default address that is set up in Claim Settings. Therefore, claims will not combine if an address is not the same, or if a service code does not have an address set in the appointment details.
To turn the “Use Service Location” toggle on/off:
- In an authorization, navigate to the “Authorizations” tab
- Hover over each of the grouped service codes and click the pencil icon on the right-hand side.
- In the “General” tab, select the Use Service Location toggle if all of the service codes in the authorization need it turned on.
- Or, turn the toggle off if all of the service codes need the toggle off.
- Once the service location is the same for all codes, the claims will be combined when they are generated.
Click here to learn how to bulk merge claims.
Click here to learn how to manually combine service lines on a claim.
Click here to learn how to automatically combine service lines on a claim.
Creating Full EDI Secondary Claims
To create full EDI secondary claims (BEST choice):
- A primary claim must leave CentralReach electronically.
- The payor must confirm they can receive the secondary claim electronically.
- The organization must receive an ERA. There can be only one payment, and that payment must be recorded from the ERA, in CentralReach, via the “Reconcile” screen.
- In #2 on the ERA, that is “and,” not “or”. If 1 and 2 are not met, then a full electronic secondary claim cannot ever be made in CentralReach.
If the above is not possible, there are three options:
- Paper claims are always available, but this cannot always be done for certain payors.
- Paper claims are not a preferred method, because the ERA will orphan.
- Use the secondary payor’s web portal. Enter the claim and payment details.
- The web portal can be efficient for feedback and getting paid very timely, due to the fact that users are inputting the secondary payor’s information in their portal. The ERA will orphan. (This method is GOOD).
- Hybrid: send a secondary claim from CentralReach, excluding the payment information. The claim will fail at the clearinghouse, by design. Then, at the clearinghouse, leverage their system to enter the payment/COB details and forward the claim from there.
- This method, while it does require hand keying part of the claim, will be compatible with the ERA and will not orphan. (This method is BETTER).
Deleting a Claim and Invoicing a Payor
If you filed a claim, but want to invoice a payor instead, void that claim and generate an invoice.
To delete a claim and generate an invoice:
- Navigate to the Claims module and select Claims Manager
- Select the claims entry you want to void and click Trash Selected
- Generate the invoices, by navigating to the Billing module and selecting Billing
- Filter by the custom date range and client
- Check all of the entries you want to invoice for
- Click the Actions drop-down and select Bulk-generate Invoices
- Choose the invoice you want to generate
Click here to learn more about creating an invoice.
Claims / Tasks
Create a New Task from the Claims Module
To keep track of action items and work pending to be completed, pertaining to claims, such as following up on a claim status to confirm it has been successfully processed by a defined due date, create tasks for claims from the Claims module. Tasks created from the Claims module include links to easily access the claims the tasks were created for.
To create a task from the Claims module:
- Navigate to the Claims module and select Claims Manager
- Click the checkbox next to all claims you want to create a task for
- Click the Actions drop-down and select Add Tasks
- In the “Create task related to X claims” pop-up, complete the form with the following information:
- Name: enter the name of the task
- Description: optionally, enter a description of the task
- Click Use a Template if creating a task using a task template
- When is it due?: click on the calendar icon to set a due date and time for the task
- Assigning a due date will enable you to filter tasks in the tasks screen and in the Tasks module’s main menu, by Due Today and Overdue
- Who is responsible?: select one of the following from the drop-down:
- You: if the task is assigned for you
- Choose someone…: to assign the task to someone else
- Find Person/Group: enter the name of the person, group, or label the task should be assigned to
- Leave unassigned: if the task should not be assigned to anybody. Use this option to create a queue of tasks that can be worked on and completed by other users in the organization
- Who can see this task?: select one of the following from the drop-down:
- All co-workers in my organization: all users in the organization can view and work on the task
- Only providers matching a label: only users with desired contact labels can view and work on the task
- Select Contact Label: enter contact labels to apply to contacts who can view and work on the task
- Is this task on behalf of a person?: select one of the following:
- Yes: if the task is being created on behalf of another person
- On behalf of: enter the name of the person the task is created for
- No: if the task is not created on behalf of another person
- Add Labels: enter labels to easily filter and organize tasks
- Attachments: click Upload, Select Files, or drag the file to the Drop files here to upload to attach relevant documents to the task
- Click Create Task
- To access the task, click the number in the Tasks column of the “Claims Manager” grid. This number indicates the numbers of tasks associated with the claim
- Or, navigate to the Tasks module and select All Tasks
- Click the name of the task
- When accessing the task, the list of claims the task was created for will be displayed on the bottom right-hand side of the task, with links to open and access each claim.