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 Claim Errors FAQ

Why does the provider not appear when I search for them in claims or when generating claims?

The provider does not appear because their claim settings were not completed.

How to create secondary claims?

Click here.

How to post orphaned data?

Click here.

Why is the “Update FTP Settings for this Gateway” error message displaying?

Click here.

Why can’t I search for an employee during claims generation to add to a claim?

If the user does not have their claims settings completed they cannot be searched for.

Why am I receiving a “Claim can Only be Paid Once” error when trying to make a secondary claim?

This means the claim has been paid more than once. You cannot make a claim from a primary claim with more than one payment. Three main rules for making secondary claims:

  • You can only make a secondary claim from a primary claim that has been sent out electronically.
  • You can only make a secondary claim from a primary claim that has been returned electronically on a payment file.
  • You can only make a secondary claim from a primary claim that has only been paid once.

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 Primary and Secondary Contacts

Primary contacts, such as the below providers, automatically populate when generating claims. These fields can be assigned or edited in authorizations, claim default settings, timesheets, or while bulk-merging claims in the Billing module. 

Any assigned secondary contacts entered in the authorization will also automatically prepopulate into secondary claims. If users do not assign secondary contacts, CentralReach will continue to use primary authorization information during claim generation. Secondary contacts will not be assigned or edited outside of the authorizations.

Primary contacts include:

  • Billing: the billing provider’s information, such as their name, address, NPI, and phone number. 
  • Referring: the referring provider’s name and NPI.
  • Provider/Supplier: the name and NPI of the physician or supplier.
  • Facility: the name, address, NPI, and phone number of the facility/location in which the service was provided.
  • Ordering: the ordering provider’s name and ID.
    • Enter the ordering provider’s information in the service line of claims, if the provider differs from the rendering provider.
  • Supervising: the supervising provider’s information, as specified in the “Supervising” tab within the “Providers” section of claims.

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.