Paper or Electronic Claims

The two choices at a glance

1. Print your own claims

Lele prints the claim on the pre-printed red form; you mail it to the carrier. One claim = one printed form: at most 6 encounters on a CMS-1500 or HCFA, 22 on a UB-04 (HCPS).

Paper: what the facility needs

• Blank red claim forms (CMS-1500 and/or UB-04) and a printer.
• Admin › Locations: the name, Tax ID and address as they should print.
• Admin › Insurance Carriers: each carrier with its mailing address (it prints on top of the claim).
• On the Location, Pin Numbers: for each carrier, the payee name and the number the carrier gave you.
• If the printing is not in the boxes: your System administrator sets your print offsets (up/down, left/right).

Paper: steps

1. Choose the client and click the Episode. The encounters must have a procedure, an authorization and the client's insurance.
2. Invoices list › New › the form. The encounters not yet billed are shown in claim groups (same location, authorization, Episode, insurance and provider).
3. Click Select on a group: its oldest 6 (or 22) encounters are ticked. Check Dx 1-4 and the claim boxes.
4. Save and Print, or Save Invoice and print later from the Invoices list › Print. Print with Margins: None and Scale 100%. The first print marks the claim Submitted.
5. Mail the form to the carrier.
6. When the remittance advice comes: click the claim › Payments, one line per procedure (see Payments).

Details: Invoices, and the whole cycle in Quick Start: My First Claim.

2. Electronic claims (HIPAA 837)

Once a week our staff sends one batch of professional claims (HIPAA 837P) for all customers who asked for electronic claims. Every billable encounter within the dates chosen by the user and Not Billed goes in, grouped by carrier. Your Finance users, typically, neither print claims nor post payments. The software handles both processes by uploading a file with all the claims, downloading the remittance advice (835) from the carrier, and posting the payments.

Electronic: what the facility needs

• To ask us to include the facility in the weekly batch.
• The insurance entered exactly as the carrier requires (see Insurance), and the client's name spelled as the carrier has it — or the payment can't be matched.
• The same Location and carrier set-up as for paper claims.

Electronic: before the batch

1. Reports list › Encounters Not Billed: these are the encounters that will go. Anything missing or wrong?
2. Each encounter needs a billable procedure, an authorization, a diagnosis and the client's insurance.
3. The service was free? Flag the encounter Donated. The client paid the whole fee? Edit the encounter and set Billed to Yes (see Encounters (Finance)).

Electronic: after the batch

1. The encounters become Billed with the date, and a HIPAA 837 invoice appears in the Invoices list. It holds many clients.
2. Reports menu › Submitted Claims Report (HIPAA): what was sent (view only).
3. Reports menu › Payment Report (HIPAA): the carriers' electronic payment reports.
4. A payment to post by hand: click the 837 invoice › Payments, choose the client in the Client drop-down, then the line (see Payments).
5. Reports menu › Submitted Not Paid Report (HIPAA): claims still waiting for payment.

Electronic: a claim must be sent again

Encounters list › Remove (Encounter) From Invoice: it goes back to Not Billed and leaves with the next batch. (An 837 invoice itself can't be rolled back.)

PsyTrace checks

• An encounter is billed only once, on paper or electronically.
• No more than 6 (CMS-1500, HCFA) or 22 (HCPS) encounters on one printed claim.
• Remove From Invoice is refused while the encounter has payments.