Processing claims

Step 1: Access Primary Billing Manager

 

1. From the left navigation menu, go to Billing.

2. Select Primary Billing Manager.

This page is where you manage your primary billing workflow.

 

Step 2: Configure Billing Rules 

 

1. Click on the Gear icon in the top-right corner.

2. This opens Billing Rules.

 

3. Toggle ON the splitting rules you want the system to follow.

4. Toggle OFF any rules you do not want applied.

 

Step 3: Generate Appointments for Billing 

 

1. Select the date: Up to which you want to generate appointments. The system will pull all appointments up to the selected date. 

2. Click Generate.

 

2. Select Payer Type: Self-Pay: Includes all patient-pay invoices, Professional: Includes insurance claims.

 

3. Select Claim Status Ready to Bill, No Show: Includes invoices for patients who did not attend

 

  1. Select Payer: Select the payer from the dropdown. 
  2. Click Go to generate claims based on your selections. 

 

Step 5: Review Claims: 

 


Claims are displayed in a table with the following details:


  1. Patient Name - Name of the patient  
  2. Date of Service - Appointment service date 
  3. Tx Provider - Provider who delivered the service 
  4. Service & Hours - Service type and duration 
  5. CPT Code - Procedure code 
  6. Place of Service(POS) - Location type of service  
  7. Modifiers - Service Modifiers (if applicable)   
  8. Diagnosis Code - Green card indicates DX code is available. Click the card icon to manage.   
  9. Units - Will display total units calculated for service hours 
  10. Rate - Will display contract rate that is in insurance contract rate    
  11. Rendering Provider -  Can be changed from the supervisor list  
  12. ID Qualifier - Editable provider identifier   
  13. Status  -  Red = Pending, Green = Ready to Bill
  14. Created Date - Claim processed Date  
  15.  Aging Date - Displays how many days from processed 

 


Steps 6: Bulk Editing Claims: 


You can select multiple claims and use the multiple edit options mentioned below.



Change Stratus:


Pending – Changes the claim status to pending for further review or processing.

Ready to Bill - Removes the claims from pending and moves to ready to bill status.


Bulk Update:

You will be able to update multiple claims in bulk as outlined below.

  1. Payer
  2. Remove from Billing
  3. Rendering Provider
  4. CPT Code
  5. Diagnosis Codes
  6. Modifiers
  7. ID Qualifier
  8. Place of Service (POS)
  9. Treatment Provider to Rendering Provider
  10. 24J Provider to Practice NPI
  11. Round Off Units
  12. Update Rate
  13. Fetch Billed Rate (from insurance rate list)
  14. Fetch Contract Rate (from insurance rate list)



Retract: 

Use Retract to remove multiple claims at once.

 

Steps 7: Batching Claims: 


 


Generate Batch: You can batch claims together after selecting them. 

  1. Creates a batch
  2. Assigns a batch number
  3. Moves claims to Manage Billing