Billing Manager Claim Buckets

            Introduction

            A description of each of our claim buckets and the claim types they contain

            More Information

            Bucket

             

            Status

             

            Description

             

            For Follow-up

             

             

             

             

             

             

             

             

             

             

            Statements Not Going

             

            Claims for accounts with statements on hold. Also includes accounts where pre collection cycle is completed.

             

             

             

             

            Neglected Svc Details

             

            Claim lines that have not been submitted

             

             

             

             

            Pending Rebill

             

            Claims that have been tagged for rebill that need editing

             

             

             

             

            On Hold

             

            Claims that have been placed On Hold

             

             

             

             

            Credit Balances

             

            Any claim with a credit balance on a line item

             

             

             

             

            EHR Imports

             

            Claims imported from your electronic health records system

             

             

             

             

            Denied Svc Details

             

            Denials posted, and claim line not resubmitted yet

             

             

             

             

            Pending

             

            Any claim detail that has had transactions posted to it, but has not yet been resubmitted to a new debtor (when it is resubmitted, it will be removed from pending status)

             

            Errors

             

             

             

             

             

             

             

             

             

             

            EDI Claim Errors

             

            Claims that fail PA's EDI edits when claim file is created

             

             

             

             

            EDI Rejections

             

            Claims that have been rejected by Payor

             

             

             

             

            Pmt Processing Errors

             

            Payment could not process due to error.  Open payment application and click "unposted button"

             

             

             

             

            Import Errors

             

            Claims with import errors

             

             

             

             

            Processing Errors

             

            Claims with errors

             

             

             

             

            Concurrency Errors

             

            Anesthesia claims that exceed concurrency limits

             

             

             

             

            Show All

             

            Shows all statuses for the Error bucket

             

            Awaiting release

             

             

             

             

             

             

             

             

             

             

            Pre-Released

             

            Claims with incomplete information, or claims that the user does not want to submit immediately

             

             

             

             

            For Review

             

            Claims that are ready for review

             

             

             

             

            Concurrency

             

            Anesthesia claims that require concurrency processing

             

             

             

             

            Show All

             

            Shows all statuses for the Awaiting Release bucket

             

             

             

             

             

            Released

             

             

             

             

             

             

             

             

             

             

            Awaiting EDI Submission

             

            Claims that are waiting to be submitted by EDI

             

             

             

             

            Awaiting Printing

             

            Claims that are waiting to be printed on a HCFA form

             

             

             

             

            Pending Statement

             

            Self Pay claims, or claims transferred to the patient, where a statement has not yet gone

             

             

             

             

            Pending Invoice

             

            Industrial Account claims where an invoice has not been sent yet

             

            Submitted

             

             

             

             

             

             

             

             

             

             

            In EDI File

             

            EDI file has been created, and is pending transmission.

             

             

             

             

            EDI File In Transit

             

            EDI File is being processed by the EDI servers

             

             

             

             

            Submitted by EDI

             

            EDI file has been successfully transmitted, no confirmation received from payer yet

             

             

             

             

            EDI File Confirmed

             

            Payer has confirmed that the EDI file has been received

             

             

             

             

            EDI Confirmed Claims

             

            Positive confirmation has been received from the payer system that the claim has been received and accepted for processing

             

             

             

             

            Medicare Crossover

             

            Medicare payment file shows that claim was crossed over to secondary payer

             

             

             

             

            Submitted by Mail

             

            Claims printed by user on local computer

             

             

             

             

            Billed to Patient

             

            Self Pay claims with statement sent OR

             

             

             

             

            Claims transferred to patient, and statement sent

             

             

             

             

            Billed to Industrial

             

            Industrial Account claims where an invoice has been sent

             

            By Patient

             

             

             

             

             

             

             

             

             

             

            By Patient (OS Claims)

             

            Shows all outstanding claims for the patient selected in the patient combo box on claim general, or the patient name selected on PA Today (which would override any patient name on the claim general form)

             

             

             

             

            Changes the columns in the grid to be DOS/Claim ID/Balance/claim status/status date

             

             

             

             

            By Patient (All Claims)

             

            Shows all claims for the patient selected in the patient combo box on claim general, or the patient name selected on PA Today (which would override any patient name on the claim general form)

             

             

             

             

            Changes the columns in the grid to be DOS/Claim ID/Balance/claim status/status date

             

             

             

             

             

            All Claims

             

             

             

             

             

             

             

             

             

             

            All Outstanding

             

            All claims with an outstanding balance

             

             

             

             

            All

             

            All Claims

             

            Processing

             

             

             

             

             

             

             

             

             

             

            Awaiting Pmt Processing

             

            Payments that are waiting to be applied to the account

             

            Collections

             

             

             

             

             

             

             

             

             

             

            Collections - O/S

             

            Claims transferred to collections, but not written off

             

             

             

             

            Collections - W/Off

             

            Claims transferred to collections, and written off

             

            Inactive

             

             

             

             

             

             

             

             

             

             

            Paid

             

            Paid claims, or any claims that have a $0 balance as a result of posted adjustments or write-offs

             

             

             

             

            Old (Txfer/Resub/W-O)

             

            For claims that have been fully adjusted off via the resubmit or transfer to secondary processes

             

             

             

             

            Voided

             

            For claims that have been voided

             

             

             

             

             

             

             

             

             

             

             

             

            Updated: 05 Sep 2017 10:56 AM
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