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Benefits of using this feature:

Claims tracking will allow you to track submitted claims

via the claims tracking panel.

Setup:

1. Enable Track claims under Setup > User administration > Users> Edit privileges.

2. Navigate to Setup > 3rd party payers > double click payer > check Track claims.

Workflow:

When creating a sale with an insurer that has the ‘track claims’ checked off, the “To be submitted to insurance” checkbox on the allocate costs screen will be automatically checked

indicating we need to submit the claim.

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You will notice that you are unable to allocate money to the 3rd party payer. This is because you no longer need to separate the patient portion from the 3rd party payer portion.

Once the sale is saved, you can find the sale in the claims tracking panel under the pending claim submission tab. The pending claim submissions panel will track all invoices and orders that have not had a claim submitted to insurance.

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Pending claim submission

You will have several options in the pending claim submission panel:

• Transaction details will allow you to view the invoice and adjust a limited amount of information.

• Edit invoice will allow you to view the invoice and adjust all information.

• Prepare HCFA will populate the prepare claim module. This is only available for customers who have a clearinghouse integration.

• Does not require submission willuncheck the to be submitted to insurance checkbox on the invoice and remove it from the pending claim submission panel.

Submitted claims

This tab will show the submitted date, invoice #, claim #, patient name, location, 3rd party payers, amount paid, credit amount, and open balance.

Within each claim you will have several options:

• R-click the submitted claim > Patient > Receive/apply payment, Request online payment, Write-off. You can also do this by hovering over the patient’s name.

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• R-click the submitted claim > select the 3rd party payer > Change status > mark the claim Acknowledged, Closed, Denied, Rejected, Reopened.

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• R-click the submitted claim > Resubmit HCFA, Close claim, Claim history.

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• Hover over the Claim # column to add a note or view claim history. The claim history will track user movement on the claim.

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• Hover over the open balance amount to see the invoice amount as well as the submitted amount.

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• Receive/apply bulk payment at the bottom of the screen can be used

• to enter bulk payments for several claims.

• 3p payer payments will appear on the patient file. Claim status will change to “paid” automatically.

• Write-offs will change the claim status to “adjusted” automatically. This will also appear in the patient file

• Patient file > 3p payers section will show the claim history with the same details as the claims tracking panel

• Patient sales history will have a new icon when the invoice requires submission. A document with a green checkmark means the claim was submitted. The payment icon means a payment was taken. entire balance will remain on the patient.

• R-click sale > view HCFA will show you the submitted claim

• Once the claim is fully paid it changes the status to closed. Closed claims are removed from the submitted claims section in the claims tracking panel.

• Insurer claims (Excel only) is a new report created. It shows pending claims submission and submitted claims. This report goes off of the order date.