Claims
Claim Scrubbing Errors
Claim Scrubbing Errors When you release a claim, the ProviderSuite Claim Manager processes that claim to get it ready for transmission to the payer. During Claim Manager processing and before sending to the clearinghouse, the claim is "scrubbed" by ...
Claim POS versus Service Line POS
There are differences between paper and electronic claims when it comes to Place of Service (POS) codes. On paper claims, the POS code goes in Item 24B at the Service Line level. For electronic claims, however, there is a POS code for the overall ...
Why do some claims go to the Pending Payer Paper Claim bucket?
There are several reasons why a released claim may end up in the Pending Payer Paper Claim bucket. The insurance plan selected on Claim-General does not have a Payer ID. There is an insurance plan mismatch on the claim, e.g. the claim is ...
How to use the Claim Final Tab Attachment Details Feature for PWK, EOB, COB or MSP
You can now fax or mail your EOB or other documents and send details in your claim so the payer will match up your claim and documentation as received. Just add information to the document and the payer will link the document(s) with your claim ...
How to use the Claim Final Tab Attachment Details Feature for Op Reports
You can now fax or mail your Medical Reports and send details in your claim so the payer will match up your claim and documentation as received. Just add information to the document and the payer will link Medical Reports with your claim submission. ...
2018 ICD-10-CM codes take effect October 1, 2017
The new 2018 ICD-10-CM codes are to be used for discharges occurring from Oct. 1, 2017 through Sept. 30, 2018, and for patient encounters occurring from Oct. 1, 2017 through Sept. 30, 2018. In this year's new code set there are 363 new codes, 142 ...
NUCC 1500 Health Insurance Claim Form Reference Instruction Manual
This NUCC Reference Instruction Manual provides specific instructions on how to complete the 1500 Claim Form. Instructions and information provided align with the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837), ...
Claim Followup Concerns Escalation
The healthcare claim payment workflow is a complex process – from initial claim entry through to payment. The claim follow-up process has multiple steps that each require your attention: entering a new claim, resolving claim scrubbing errors, ...
Viewing EDI Rejection Message
How to view an EDI Rejection: From the Today screen in PA Billing Double-click on the bucket "EDI Rejections" -- a list will appear on the right of the screen Double-click on a patient in the list, this will load the claim into the "Claims General, ...
Update EDI Rejection Status
If a claim does not belong in EDI rejections you can manually update the status following these steps: From the Today screen, double click the EDI rejection bucket From the list on the right, double click the patient and DOS you want to update From ...
Trans in the CTD window
From the Claim Transaction Detail Screen for a specific Claim: 1. Click on the Red line with the Balance and the CPT Description 2. In the box that opens below use the drop down box next to Transactions and pick an adjustment that matches the event ...
Submitting secondary Claims
To submit claims to the secondary payer, ensure the following are present before releasing the claim to the payer: 1. Primary Insurance payment (if $0.00 no payment or adjustment is needed) 2. Allowable amount from the primary payment 3. Patient ...
Set Flag for Emergency Claims
To enter a "Y" in this field you will need to update the Core Practice setup information using the following steps: Go To the Setup Tab Under General scroll down and to the right check the box labelled "Include flag for emergency services" Then click ...
Resolve Batch/Payment Awaiting Processing Error
How to find the awaiting processing batch: 1. From the claim transaction detail screen, click on the Transaction that is bold with Awaiting Processing Error(s) message 2. Click the "Go To Payment" button in the top right corner - this will take you ...
Remove Prior Authorization from Claim
Here are the steps I used to remove the prior authorization number from the claim. Pull up Claim# (?)> Go to the Claim - Details Tab> Single click on charge line one> Click on box "Applied Authorizations" > Click on Line # (?) > Click on the "Clear ...
Remove Posting Error
Part 1: How to find the posting error description 1. From the claim transaction detail screen click on the Transaction that is bold with Posting Errors. 2. Click the "Go To Payment" button in the top right corner. 3. Read the "Error Description" ...
Refund Patient
From the Claim Transaction Detail Screen for the claim with a credit balance: 1. Click on the payment line that created the credit balance (most likely the patient payment) 2. In the box that opens below, use the drop-down box labeled Transactions ...
Processing Error - Cannot Submit a claim
Please follow these steps for claims that are in Processing Errors status and the Error reads-Cannot submit a claim detail that exists in an active claim final version. 1. Load the claim into Claim-General 2. Uncheck the box next to the red service ...
Printing Settings for 1500 Form
To print a 1500 form and update the margins. 1. From Billing Manager,Select the Option "Print" and then select "Claims" 2. In the Print Claims Box, Click the Print Settings button 3. Click "Print Test form" and Select the Printer needed 4. For the ...
NDC: 11 versus 10 Digits
When submitting NDCs on professional/ancillary electronic (ANSI 837P) or paper (CMS-1500) claims, you must enter the NDC on your claim in the 11-digit billing format (no spaces, hyphens or other characters). If the NDC on the package label is less ...
Industrial Account Create and Print
Steps for creating and printing new Uninvoiced Industrial Account Claims In Billing Manager > Practice Management – Print- Invoices First step is to create invoices First change the selection from Print Invoices to Create Invoice Data Invoice Date ...
How to add Patient's Home to the Facility Drop Down
If you are in Billing Manager and are unable to select "Patient Home" from the Facility drop down it may be because you don't have a default facility selected for your provider. Here are the steps to correct this problem- Go to Setup Click Providers ...
How are Anesthesia Charges Calculated
The system takes the total of the base and time units and multiplies by the Anesthesia Conversion Factor. For example, take ASA code 00142. If you add a start time of 08:00 and an End Time of 10:30 the base units are 6 and the time units are 10 (4 ...
Electronic Secondary Claims
There is currently an issue in ProviderSuite processing electronic secondary claims. As a temporary workaround, you can print this claim on a 1500 Form and mail it with a copy of the Primary EOB. This ticket is being escalated to level 2 support as ...
Edit Payment from CTD screen
Here are the steps to edit a Payment Transaction Type from the Claim transaction detail screen. 1. Launch Billing Manager 2. Go to Claim- General Tab 3. Search and find your patient 4. Click on the Patient transaction history button 5. Double-click ...
EDI Claim Error for Corrected Claim
If you have received an EDI Claim Error for Original Reference number for your corrected claims please see the information listed below. 1. To send a corrected claim to a payer, the claim must have been previously accepted by the payer and responded ...
EDI Claim Error - Processing Errors
Here are the steps to resolve. 1. Pulled up claim # 2. Go to Claim-Details tab 3. Uncheck line items and then recheck, saying OK or yes to any pop up boxes 4. Release the claim as New.
EDI Claim Error - Processing Errors
Here are the steps to resolve. 1. Pull up claim id# in Claim - General 2. Go to the Claim-Details tab 3. Uncheck any red line items and then recheck, saying OK or yes to any pop-up boxes 4. Release the claim as New
EDI Claim Error - Applied to Ded
This EDI Claim Error is happening because of the transaction "Applied to Deductible". You can fix this issue following the steps listed below: 1. Double-click on the EDI claim error bucket 2. Double-click on one of the patient claims 3. Go to the ...
CMS 1500 (02/12) Qualifiers
Qualifiers are codes that are now required for the new 1500 (02-12) claim form in order to state if the date being listed is due to an onset date or some other reason. You can find information at the following website for usage of the new claim ...
Change Claim Status Button
You can manually update the status of your EDI Rejection claim to Submitted by Mail using the following steps: Double-click on the EDI Rejection Bucket Double-click on the claim you need to update In the upper-right corner click the button "Change ...
Can't Print Claims-Rjctd by Clearinghouse Status
The Print Claims button was greyed out because the claims were in the status Rjctd by Clearinghouse/Payer. Under the Claim ID: box there was another box called Change Claim Status. I changed the status of the claims to Submitted by Mail. Now for the ...
Adjustment Reversal in CTD
From the Claim Transaction Detail Screen for the patient claim 1. Click on the blue adjustment line 2. In the box that opens at the bottom of the page remove any dollar amount and leave the amount box blank 3. You can enter remarks as a reminder of ...
Add an NDC Code
To add an NDC Code: 1. Go to the Claim - Details screen in Billing Manager 2. Check the box labeled Drug 3. Enter the CPT code that needs the NDC attached (the CPT cannot contain any extra characters) 4. Tab through to Diagnosis Pointers and click in ...
Including PQRS codes on a Billing Applet claim
Per the CMS FAQ at https://questions.cms.gov/faq.php?id=5005&faqId=2125 How and where should I place the Healthcare Common Procedure Coding System (HCPCS) CPT Category II codes or G-codes on the claim for the Physician Quality Reporting System ...
CPT Modifiers
Proper use of modifiers with procedure codes is essential to submitting correct claims. The AMA’s CPT code book includes HCPCS Level II codes and modifiers, while the HCPCS code book includes HCPCS Level II codes and related modifiers. Resources ...
Creating Claim Files 101-AFC
CREATING CLAIM FILES 101 1. Once you have logged into PA, go to the Admin tab, you will be on the option for 837s. 2. Under "Create 837 Files" look for the EDI Services dropdown menu and choose the EDI Service you want to create a file for. The ...
How to include Emergency Flag indicator on Claims
Question- How to I add an Emergency Flag indicator on Claims To enter a "Y" in this field you will need to update the Core Practice setup information using the following steps: 1. Go To the Settings Tab, under Account scroll down and to the right ...
How to view EDI Rejection messages on claims
Question- How do you find claims that were rejected from the clearinghouse? Do I have to run a report? Answer- You don't have to run a report to find your rejected claims. Use following steps to view an EDI Rejection from PracticeAdmin Billing ...
How to Delete or Void a Claim
Deleting or Voiding a Claim Unreleased claims can be Deleted, Released claims cannot be Deleted, they can only be Voided. Released claims with payments applied cannot be Voided until those payments are reversed or removed. Deleting and Voiding are ...
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