Claims Manager

Claims / Claims Manager How to Download the Claims Report

The Claims report contains all claim data in the  Claims module.

To download the Claims report:

  1. Navigate to the Claims module and select Claims Manager
  2. Choose a desired date range by selecting the calendar at the top of the screen
  3. Filter the screen and click the  cloud icon on the right-hand side 
  4. Select CSV or Text file
  5. The file will be generated and located in the  Files module

Claims / Claims Manager Adding Existing Billing Entries to a Claim

To add a new billing entry to a claim:

  1. Navigate to the  Claims module and select Claims Manager
  2. Find the claim you need to edit, or search for the claim ID in the search bar
  3. Click the Actions  drop-down on the right-hand side of the grid and select Edit
  4. Click Services on the top of the claim
  5. Click Add New  under Service Lines and select one of the following:
    • Add Manual Line: if the billing entry has not been created in CentralReach
      • Enter the service details
    • Add Existing Billing Entry: if the billing entry has already been created in CentralReach. Once clicked, a pop-up will display the list of billing entries with the same client and the same billing date as the entries already registered in the claim. Billing entries already included in other claims will be excluded from the list
      • Click the box next to the billing entries(s) that need to be added to the claim
      • Click Apply Billing Entries

6. Click Save Claim

Note: If you are adding a line item that is the same date and code as one already on the claim, this action will not ‘combine’ the units and dollar amounts together, instead it will submit the line items as they read on this page (i.e. you could be creating a duplicate).

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

4. 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 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 of the claim responses

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 payor 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.

CC1

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 Print Text Only on a Pre-loaded CMS 1500 form

To print text only on a blank, preexisting CMS 1500 form:

  1. Navigate to the Claims  module and select Claims Manager
  2. Select the claims to be exported. Navigate to the Actions drop-down and select Export/Download.
  3. Choose to download CMS 1500 (PDF) and check off Ignore Errors
    2017-02-23 16_54_20-claims - CentralReach
  4. Click on download from the “Claims export progress” window on the bottom-right
    Claims export progress window
  5. A pop-up window will come up to save the file locally. Right-click the Download link and select Save link as…
  6. Open the local file with your system’s PDF reader. Navigate to Save and Print Options and select Print Text Only
    2017-02-23 17_01_45-3368002d80334e848d2fd14b8cd7c222.pdf - Adobe Reader

 

Claims / Claims Manager Pull Another Office Location Address to a Claim

To pull information, such as NPI, tax ID, or address of another office location into a claim, you first need to create a generic contact for such location, via the  Contacts module. Click here to learn how to create a generic contact.

Once the office location is added via a generic contact, complete the Claim Settings of this office location contact:

  1. Navigate to the  Contacts module and select Generics
  2. Select a contact
  3. Click the Profile tab on the top of the Dashboard
  4. Click the Settings tab and select Claim Settings
  5. Complete the form with all of the information pertaining to your office location
  6. Click Save Claim Settings

Once done, you can pull your generic contact office location information into your claims.

Claims / Claims Manager Split a Claim by Provider

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, and PT.

To begin:

  1. Navigate to the Billing  module and select Billing.
  2. Check the billing entries to be split. Navigate to the Actions drop-down and select Bulk Merge Claims
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  3. On the next screen, there will be one claim for one client. Check Split on Providers. The claim will split into one claim per client and per provider. 2017-03-29 16_26_50-
  4. Click Start claims generation once all changes have been finalized on the current, bulk-merge screen. 2017-03-29 16_19_57-
  5. Once the claims have been processed, the claims can be submitted. To submit the claims, navigate to Go to claims inbox.
  6. Check the claims to be submitted. Navigate to the Actions drop-down and select Send to Gateway2017-03-29 16_28_21-

 

Please note, while this feature is primarily designed for one client at a time, this feature is able to handle multiple clients and staff. If handling more than one client, please be aware each step may take longer to complete.

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 are analyzing the HCFA-1500 claims, 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 module then Claims Manager
  2. Find a generated claim and click on Actions  and Edit
  3. Under the Provider tab, 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 which box number of the HCFA-1500 the information belongs to, and what that box translates to on 837P

4. Clicking on Add allows you to view the client’s default claims settings. You can also change those defaults from here

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.

SL3

 

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.

SL3-2

 

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

SL4-2

 

 

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 Include Times for all Claims

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.

  1. Navigate to the Billing module and select Billing
  2. Select the checkboxes next to the billing entries
  3. Click the Actions drop-down and select Bulk-merge Claims
  4. Check the Include Times box during the bulk-merge process
    • The screen shots here will utilize the same dates for consistency, pulled from the longer article about RBT submissions to TriCare

Screen Shot 2016-02-29 at 10.39.26 AM

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

  • Please note, if the time is split the multiple times will appear, as well

Screen Shot 2016-02-29 at 10.43.59 AM

6. 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 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:

Screen Shot 2015-09-02 at 4.13.01 PM

Example of ICD-10 usage:

Screen Shot 2015-09-02 at 4.13.25 PM

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.

Screen Shot 2015-09-02 at 4.19.17 PM

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.

Screen Shot 2015-09-02 at 4.22.05 PM

 

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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.

Screen Shot 2015-09-02 at 4.29.12 PM

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.

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Claims / Claims Manager 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 payor you submitted to in the first place. Without the internal identifier from a payor, the payor 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 payor’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 payor’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 payor’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.

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.

Screen Shot 2015-08-09 at 9.59.03 AM

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.

Screen Shot 2015-08-09 at 10.01.21 AM

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:

Screen Shot 2015-08-09 at 10.04.56 AM

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.

Screen Shot 2015-08-09 at 10.12.14 AM

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.

Screen Shot 2015-08-09 at 10.14.16 AM

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:

Screen Shot 2015-08-09 at 10.21.18 AM

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.

Screen Shot 2015-08-09 at 10.26.31 AM

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)

Screen Shot 2016-02-29 at 10.39.26 AM

 

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. 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.

Screen Shot 2016-02-29 at 10.48.39 AM

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 Bulk Merge Claims

After you have performed any type of auditing/scrubbing prior to this stage, you are ready to submit claims.

To generate and submit claims:

  1. Navigate to the Billing module and select Billing

2. Select the items you want to place on a claim, by clicking the checkbox  next to the claims

3. Click the Actions drop-down and then Bulk-merge claims

4. You will be brought to the first stage, where your claims will be separated by client, for you to review a few of the main fields

5. All of these fields come over directly from each individual timesheet. Edit them on the timesheet to fine tune anything. The fields visible here are as follows:

  • Diagnosis code: if it is not here, set it as 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, get out of this screen and edit the individual timesheet
  • 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: 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
  • Payor: the payor associated with this service line. If incorrect or missing, go back to the billing screen and adjust it on the timesheet
  • 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 the checks need to be sent and is also the information used to populate the EIN on the claim
    • Please note, unless you have multiple offices or tax id’s/NPI’s the info for Location and Billing are generally the same
  • Referrer: this is for referring physician, box 17
  • Provider/Supplier: the information for box 31, Rendering. It can be adjusted on the timesheet

6. 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 search  icon next to Provider, and you can enter a different name

  • If you try to add someone and their name does not appear, it means that the employee does not have Claim settings in their contact information
    • Go to the Employee’s Dashboard
    • Click Profile and then Settings
    • Click Claim Settings and enter their info as needed
    • Click Save Claim Settings

7. The reason that provider is editable here is because, when you submit, you want box 31, and the NPI, etc. to match the info you are sending in box 24j, the line item NPI, etc

  • To do so, 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 or the payroll information

8. 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 timesheets will come over in Separated View, where every timesheet 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, 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 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
    • 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

9. 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, edit, and export it as a paper claim. Or, send it to your electronic gateway, etc

10. Navigate to the  Claims module and select Claims Manager. Here, the system will scrub the claim further, looking for data in all of the boxes, per your individual Org settings

11. When you arrive, you will be in the inbox and the claim(s) you just generated will be there, as well. Ideally, there should not be any errors. If you have any, the claims data is being scrubbed even further. We always recommend using the error messages to clean up claims, as well as your database

12. If there are no errors, you can skip toward the end. If you do, like this claim, simply click the edit icon and the claim will open in the claim editor and point you to the error(s) the system found

13. The 10 errors we have are distributed through 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

  • When fixing things here, go back to the respective area in your CentralReach database and update the items there, as well, that way within a week or two you can start getting errorless claims every time

14. Now that the claim has no errors, we can submit. To do so, select the claim and then the Actions drop-down button will appear

15. 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
    • 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 clearinghouse we support, you can electronically submit claims via the gateway

16. We recommend using a gateway. Not only does it speed claims submission, it speeds payment and responses, too. If you also receive the 835/ERA files, it can really change/simplify the AR reconciliation process of all individual billing entries

Claims / Claims Manager How to Accept Electronic Payments

CentralReach offers the ability to receive responses (payments/rejections) from insurance companies electronically, via Office Ally.

To access your electronic responses:

  1. Navigate to the Claims module and select Claims Manager
  2. Click the Responses tab. To access only payments, click the Payments tab
  3. Click the + to the left of the claim ID, to expand the payment information. Once the information has expanded, click the eye icon on the right-hand side to open the payment reconciliation page
  4. 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 Unable to Load Payor for Gateway

When sending claims through the gateway, an error message will display if the insurance company’s payor ID is missing from a client’s insurance information and/or no plan has been selected.

export error

If you receive this error while trying to send claims through the gateway in the  Claims module, verify the information is missing by:

  1. Navigating to the  Claims module and selecting Claims Manager
  2. Click on the payor listed on the claim you are trying to export
    • If the required information is missing, it will reflect in a pop-up box

Open a support ticket for one of our specialists to add a payor ID to your account.

Claims / Claims Manager Manually Edit the Provider/Supplier within a Claim

To manually edit the provider/supplier within a claim:

  1. Navigate to the Claims  module and select Claims Manager
  2. Locate the claim to be edited. Click on the Actions drop-down and select Edit
  3. On the next screen, navigate to the Provider/Supplier tab

Please note, the information listed under “Last/Organization Name”, “First Name”, and “Provider Signature” will appear in box 33 of the HCFA 1500 form. Also, if there is no signature on file for the given provider, the provider can manually sign the form after it has been printed.

Claims / Claims Manager Submitting a Claim from a Secondary Insurance

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

To start:

  1. Navigate to the Billing module and select Billing
  2. Click on the dashed line underlining the Payor. Select the secondary insurance the claim is being submitted to under the drop-down menu. Click on the red check to save.Selecting 2nd
  3. Check the billing entries to be submitted. Navigate to the Actions drop-down and select Bulk Merge claims
  4. Once changes have been finalized, navigate to Start claims generation and select Go to claims inbox. The secondary payor should now be listed as the payor in this window.
  5. To edit the claim, navigate to the Actions drop-down and select Editclaim wi 2nd as prmary
  6. Under the COB tab, navigate to the Choose Payer drop-down to select the primary payor as the “Other Insured”.  The information for the primary payor will populate automatically. However, additions and changes can be made to any missing pieces of information.

    Please note, make sure the first and last name are correctly entered and what is listed under the “Policy/Group/FECA Number” is the primary insurance ID number.
  7. To populate the amount paid by the primary insurance, or other payor, under box 29 on the HCFA 1500 form, navigate to the Claim tab and enter the value under Amount Paid. Click Save Claim in the upper-right corner.
  8. The form is now ready to print. To print the form, navigate to the Claims module and select Claims Manager
  9. Check the claim to be printed. Navigate to the Actions drop-down and select Export/Download. Check Ignore errors

  10. Navigate to the Claims Export Progress window in the bottom-right corner and select Download

  11. Open the PDF File
    Screen Shot 2015-11-04 at 8.31.04 AM
    The information for the primary and secondary payors should already be in 9 and 1, respectively, with box 11d checked for Yes. The information in box 29 contains the amount already received. For example, if you received $0.00, make sure to enter that amount in.
    Please note, once the payor information has been changed from the billing screen, receivables will reflect the money owed by the secondary payor, not the primary payor.

Claims / Claims Manager How to 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. This does not alter the original timesheets or billing entries, ensuring an accurate history for payroll and billing purposes.

To combine these entries, start by generating a claim:

  1. Navigate to the Billing module and select Billing
  2. Select the entries you want to submit and click Bulk-merge claims from the Actions drop-down
  3. In the next screen you will see two tabs at the top. You will be defaulted into the Separated Claims View tab. While in this tab, you will see all of the billing entries that were selected to be merged onto the claim

4. Click on Combined Claims View and you will see all of 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 can combine or un-combine service lines

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

Claims / Claims Manager How to Manually Combine Service Lines on a Claim

The Claims Manager gives users the ability to manually alter claims and combine dates of service. This does not alter the original timesheets or billing entries, ensuring an accurate history for payroll and billing purposes.

To combine these entries, start by generating a claim:

  1. Navigate to the Billing module and select Billing
  2. Select the entries to be submitted and click Bulk-merge claims from the Actions  drop-down
  3. In the next screen, there will be two tabs at the top. The default tab is the “Separated Claims View” tab. In this tab, all of the selected billing entries will be merged onto the claim.
  4. Navigate to the Actions drop-down on the far right and select Edit.
  5. On the next screen, navigate to the Services tab

  6. Navigate to the Add New  drop-down under “Service Lines” and select Add Manual Line
  7. Provide the claim information and the rendering provider.

  8. Once complete, users have the ability to delete the other entries by clicking on the on the right.

Claims / Claims Manager Create and Apply Labels in the Claims Manager

You can create and apply customized claim labels to better manage your claims.

To create claim labels:

  1. Navigate to the  Claims module and select Claims Manager
  2. There are two ways to create a claim label:
    • The first is to click on a label  icon and then the gear icon

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

3. From the pop-up, select Add new label from the Choose Label 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. When finished, click Create label

  • Examples of label names: Claim not billed, Rework claim, Claim denied, Claim requires additional data, etc.

4. To apply the label to an individual claim, click on the label  icon and type in the name of the label you want 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

5. You can also bulk apply/remove labels by checking the boxes next to them to the left, and clicking on Label Selected. Add labels to the Apply Labels box and then click Apply Label Changes

Claims / Claims Manager How to Edit Box 19 on the 1500 Form

To edit box 19 on the 1500 claims form:

  1. Navigate to the Claims module and select Claims manager
  2. Click the Actions drop-down on right-hand side of the claim you need to edit box 19

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

4. Click Save Claim

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 gear icon on the right-hand side of the billing entry
    • 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
    •  If the claim was generated more than 15 minutes ago:
      • Select X Claims Exported (view files) in the drop-down menu
  4. The claim export files page will open within the  Files module, displaying the claim file(s) export(s) available for the claim
  5. Click the file to view or download under the File Name column
  6. Click the  Download File button to download the file, or Preview to review the file details