Transcript Document

Practice Insight
Instructional Webinar Series
Claim Manager Beginner
Presented by:
Shaun McAnulty – Product Training
Specialist
Agenda
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How to Use F1 Help
Transfer Files
Uploading Files
Check Searches
The Working Life Cycle of a Claim
Claim Manager’s Layout and Buttons
Organizing & Working Claims
Question & Answers
Upcoming Webinars
F1 ONLINE HELP
• This is the manual with tips and definitions of the fields you
see throughout the software.
• The guide is broken into categories to better locate the
information you’re looking for.
• When using the F1 key the system will use your focused
location in the software and display the information
relevant to the information you’re viewing.
TRANSFER FILES
Transfer Files is where
you can upload claim
files, and view all of
your responses.
UPLOADING FILES
Integration
• Claim files are automatically
brought into the system and
Tested.
• Files can be set to auto ready
Manual
• Simple process to browse to
file location and upload claim
files.
• Easy process.
TRANSFER FILES
Uploaded Files : Shows a full history of
files that have been uploaded to the
software from the Practice
Management System.
Response Files : Section
shows all of the responses that
are received for the selected
customer.
CHECK SEARCHES
• The Filter List Button allows you to search for ERAs or
Checks.
o From here you can Repost the files, View the EOBs or
Download the files.
• In SEARCH TOOLS the Check Search Tool has a wide
variety of criteria and allows you to view the
individual checks, and their Specific EOB.
CLAIM MANAGER LAYOUT
Life Cycle Of A Claim
EDI ACTION
PAYER ACTION
USER ACTION
CLAIMS LOADED
(Integrated)
UPLOAD CLAIM FILE
(Manual)
EDI TESTING
(Clinical Scrubbing)
VALID
INVALID
FIX CLAIM
READY
NO
BATCHED &
SENT
YES
Acknowledgements
(ACK-997, ACK)
Where
COMPLETE
PAYER
RESPONSE
EDI Insight processes the
Payer responses and will
attach them to the
corresponding claims.
Marking the new claim
status in EDI Insight as
well.
ACCEPTED
PAID
REJECT
IN
OR
PRACTICE
MANAGEMENT
EDI CLAIM
MARK DELETE
& RE-BILL
DENIED
MARK APPEAL
DELETES: Will not
show on reports.
WORKING CLAIMS
Select my invalids & rejects.
With Invalids & Rejects displayed I will bring
my invalids to the top by sorting on the Status.
*All field headings with an asterisk allow for sorting.
INVALID CLAIMS
Remember: On INVALID
claims with a TESTER
source you can simply
double click on the error to
take you to the general
location of the problem.
There are multiple ways
- Read it in the column
- Use the hover text
- Or use the Right Click or Hot
Key “M” for message.
With the claim highlighted it will display all of the history for the claim in the Status
Messages section. Use the following steps to work Invalid Claims.
1.) Read the Error
Message
2.) Based on your
workflow fix the
claim
Fix Now: Add Last Name and Save
Fix In PM: Mark Claim Delete and fix
it in the PM then resubmit.
3.) When Valid
set to Ready.
REJECTED CLAIMS
“M”
Similar to the process of working an invalid claim you would highlight the rejected claim and
view the response error to understand the issue. Once you have looked into the rejection
then you will refer to your own workflow.
Fix it Here
Make the adjustment
Ready claim
Fix it on the
PM
Nothing to
Fix
Mark claim deleted
Fix on PM and
resubmit
Mark claim
complete
BUTTONS
Transfer Files : takes the user to
where they can upload and view
claims and responses that have come
into the software.
Print Reports : allows the user to view
the Report Manager screen that
allows the user to run various
WebBrowser and Data Miner reports
pertaining to claims.
SELECTION CRITERIA
Select Claims : Displays claims
based upon the criteria the user
selects in the fields of the Claim
Selection Criteria View.
Clear Selections : allows the user
to clear all information from the
Claim Selection Criteria fields. It's
good practice to clear selections
before performing a new search.
Select Invalids & Rejects : allows
the user to select only invalid and
rejected claims.
Print Claim List : allows the user
to print a list of all selected
claims.
CLAIM LIST VIEW
Check Claim Status : Allows the
user to check the real time status of
an individual claim whose payers
name is listed in red.
Print Letter : Creates a web-based
report on the individual claim
selected.
Ready Claim : Is used to ready an
individual claim.
Retest Claim : Re-runs the
software's tester on an individual
claim.
Scrub Claim : Sends one individual
claim to the Alpha II Claim Staker to
scrub the claim for clinical edits.
View Claim Form : Views the claim
as it would look on a CMS1500,
UB04, or ADA J400 form.
STATUS MESSAGE VIEW
View Change Log : Displays an
audit of all changes made to a
selected claim.
Print Timely Filing : Generates a
letter that displays proof of timely
filing by listing all of the statuses
that the claim has gone through
including the Response File Name
that is assigned by the payer or
clearinghouse, entity that sent the
response, and batch/ File ID.
Add Memo : Allows the user to add
a memo to the status section of
the claim.
Edit Memo : Allows the user to edit
an existing memo in the status
field.
Question and Answer
Upcoming Webinars
• Advanced Claim Manager Training
• June 19th 10:00 am CDT
• Eligibility Manager Training
• June 5th 10:00 am CDT
• eStatements Credit Cards Demo
• June 25th 2:00 pm CDT