Practice InsightInstructional Webinar

SeriesClaim Manager

BeginnerPresented by:

Shaun McAnulty – Product Training Specialist

Agenda

• 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 FILESTransfer 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.

• 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.

CHECK SEARCHES

CLAIM MANAGER LAYOUT

Claim Selection Criteria

Claim List View

Status Message View

Life Cycle Of A ClaimPAYER ACTIONEDI ACTION USER ACTION

CLAIMS LOADED(Integrated)

EDI TESTING(Clinical Scrubbing)

VALID INVALID

READY

BATCHED & SENT

EDI Insight processes the Payer responses and will

attach them to the corresponding claims. Marking the new claim status in EDI Insight as

well.

Acknowledgements(ACK-997, ACK)

REJECTACCEPTED

DENIED

FIX CLAIM

YESNO

MARK DELETE & RE-BILL

Where

IN

PRACTICE MANAGEMENT

OR

EDI CLAIM

MARK APPEAL

UPLOAD CLAIM FILE(Manual)

PAYER RESPONSE

PAIDDELETES: Will not show on reports.

COMPLETE

WORKING CLAIMSSelect 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

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

There are multiple ways- Read it in the column- Use the hover text- Or use the Right Click or

Hot Key “M” for message.

2.) Based on your workflow fix the claim

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.

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

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.

“M”

Fix it Here

Fix it on the PMNothing to Fix

Make the adjustment

Ready claim

Mark claim deletedFix on PM

and resubmit

Mark claim complete

BUTTONSTransfer 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 CRITERIASelect 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 VIEWView 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

• 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

Upcoming Webinars