Overview
This article outlines recommendations for going through the daily billing tasks in an efficient way. If you follow this order you will be able to submit billing, track payments, and follow up on any outstanding claims in a timely and accurate fashion.
NOTE: This process is most ideal when one biller is completing all steps. If there are multiple staff working on various steps please be sure all steps are being completed.
Step 1: Electronic Module
- Confirm that each clearinghouse/payer report is being processed and claims have not been rejected.
- Check all batch reports that are older than three days.
- Check the reviewed column once you have confirmed no rejection(s).
Step 2: ERA Module
- Review ERA's that have not yet been processed (processed checkbox), working from oldest to newest.
- Click on the filename link to view the report from the payer.
- When you are receiving Procentive claims (claim # begins with PR), select Payment Entry Mode to add the correct payment amount and allocate it appropriately.
NOTE: We suggest you familiarize yourself with these frequently used windows. You will see links to them throughout the billing-related modules:
Additional Resources:
Step 3: Payments Module
- Add any payments that have been received outside of Procentive ERA Module: Add and allocate any payer payments.
- Add client payments
- You can use Report 1290 to see which clients have unallocated credits and a balance due.
- Check for unallocated payments/credits and allocate.
- Reminder: uncheck the Show Last 90 Days checkbox.
- Resend a Claim
- Claim Data on the X12 Summary Report
- Verifying Modifiers
- Process an ERA to a Secondary Payer
- Fill out COB (this is typically automated, however, at times manual adjustments made need to be made)
- Send Replacement or Void Claims
- Posting Takebacks
- Posting Interest
Step 4: Collections Module
- Check your outstanding invoices regularly.
- Suggestion: at least once a month.
- Use the radio button, Date last submitted to payer, at the top to view the most current re-submissions.
Step 5: Time Module
- Residential billing (if applicable)
- For residential claims, this step would only be done once or twice a month, depending on your billing cycle.
- Change the filter at the top to View: Residential
- Open the residential calendar.
- Change the applicable service lines to billable codes.
- For residential claims, this step would only be done once or twice a month, depending on your billing cycle.
- Find and resolve errors in the time module
Step 6: Billing Module
- Click Add to see what is in the billing queue.
- Identify dates (to and from dates).
- Leave the from date blank (so any "back-dated" service lines are pulled into the billing queue)
- Enter a to date of three business days prior (allowing your clinicians time to make corrections).
- Check for service lines that cannot be billed at this time.
- Note telling you how many service lines cannot be billed with a click here link to view these.
- Send claims.
Step 7: Once a month
- Create Client Statements - Report #3560
- Run this once all of the above steps have been completed.
- Run Batch Eligibility
Running Short on Time?
If you would like to send out any new claims that are in your billing queue, you can do Steps 5 & 6 above, then come back to checking Electronic Reports and allocating ERA's and Payments tomorrow.