About Claims Wizard
The Claims Wizard is used to generate new insurance claims in a 3-step process.
Once claims have been generated, you can submit and further manage/update your claims from the Claims Manager window: How to Use the Claims Manager
Before you begin: Check that you have added Billing Organization & Provider Taxonomy Codes so they are included when going to submit claims electronically.
Confirming Appointments Are Ready for Billing
We recommend running the Insurance Appointments Check flex report before generating claims to verify that appointments are ready for billing.
Information displayed in the report includes, but is not limited to:
- Is appointment rendered?
- Is there a diagnosis code?
- Is there a service location?
- Is the appointment overlapping with another service appointment?
- Is all Provider NPI info present and correct?
Generating Claims with Claims Wizard
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To generate insurance claims, select the Billing tab on the main screen of the system and then click on Claims Wizard button and a new window will open.
NOTE: You can also access the Claims Wizard from the Claims Manager window - there is a button in the top left corner to launch the Claims Wizard.
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By default, the Claims Wizard begins with the Step 1 tab open. Use the available filters to define which appointments you want to bill and click Search.
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Once your search displays appointments in the results area below, use the checkboxes on the left-hand column to select the ones you want to generate claims for and click Next.
NOTE: There are also Check All and Uncheck All buttons located above this column that you can use to make selections in bulk.
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Step 2 of the Claims Wizard will now be displayed.
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Any appointments missing required claim data such as CPT Codes, Diagnosis Code, and Rendering Providers are noted in the Errors column.
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Click on an appointment with Errors noted and Error Types are displayed in the bottom panel.
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It is recommended to correct missing data at the source (e.g., enter the missing Rendering Provider on the Client Services record and push the changes to appointments) and then return to Claims Wizard to generate claims.
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However, it is possible to enter missing data directly in Claims Wizard, click the Save icon, and continue with claims generation - but the root issue may remain for the next billing cycle.
The checkboxes for the Appointment to Claim Line Item Grouping control how appointments are combined into one claim charge line.
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In the example above, any appointments with the same Service Date, Place of Service, CPT Code, Modifier, Diagnosis Code, Rendering Provider, and Contract will be collapsed into one charge line.
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If Service Date were unchecked, after clicking Regroup, appointments with different Service Dates would be collapsed into one charge line. Typically, all options should be checked unless the carrier has special claim charge line requirements.
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Click Next to proceed to Step 3 of Claims Wizard. If uncorrected errors exist, the user will be warned before proceeding to Step 3.
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Step 3 of the Claims Wizard will now be displayed.
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As with Step 2, it is possible to correct errors directly on this page. Click the Save icon after making corrections.
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The checkboxes for Claim Line Item to Claim Grouping control which data will generate a separate claim.
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In the example below a separate claim will be generated for unique client contracts.
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A single claim can have charge lines with different Service Dates, Places of Service, and CPT Codes - up to the 6-claim charge line limit.
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Click Regroup after checking or unchecking any option.
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Click Prepare Claims to generate the claims for selected rows.
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Submitting Electronic Claims with Claims Wizard
After clicking Prepare Claims the claims just generated are displayed in Claims Manager.
Select the claims to be submitted and then click on submission options.
Depending on your partnered clearinghouse, the submission options dropdown in the Claims Manager will contain one or more of the following options:
- Send 837P (Office Ally)
- Send 837P (Apex)
- Both options may be visible if your practice is in the process of migrating from one clearinghouse to another.
If the practice is using Kareo for billing, then the Send to Kareo option will be present.
Similarly, if your practice is migrating from Kareo to the system’s Billing, options to send to both Kareo and a clearinghouse option may be enabled.
If the system’s Billing feature is not enabled for a practice, the allowed options in the Export Claims dropdown are Export 837P (Office Ally) and Send to Kareo - if the practice uses Kareo for billing.
When Send 837P (Office Ally) or Send 837P (Apex) is selected - the Submission Date, and Submission Type are automatically updated. The Status will change to Submitted - meaning the system is waiting for confirmation of acceptance or rejection from the clearinghouse.
The system will check if the same claim has been previously submitted to avoid duplicate claim submittals. Clearinghouses can take up to 48 hours to send back an acceptance or rejection notice.
If the prior submittal was within the last 24 hours, The system’s Billing will not allow a resubmission.
After 24 hours, the user is warned but can proceed with a resubmittal.
Once your claims have been generated, you will be returned to the Claims Manager, where you can further edit, submit, and track the status of your claims.