This document will provide step by step notes on how to navigate through the Primary Claims Wizard. The purpose of the Primary Claims Wizard is to validate charges against payor requirements and create the paper and/or electronic claim to be mailed or transmitted to the payor.
In the system:
- Click Claims and then select Primary Claims Wizard.
- Choose the Post Thru Date. (this should be the last date of service posted for each level of care)
- Click Next.
Depending on the facility, there could be different Levels of Care. (for example IP and OP).
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- The user does not have to change the Post Thru Date on both at the same time.
- IP claims can have a different posted through date than OP claims.
Add Claims
On the Admission Selection screen of the Primary Claims Wizard the user has several options to add claims. The most common is to Select Add All. This function will add all patients with unbilled charges.
Patient’s can be added one at a time with the Select Admit combo box, or use the single add icon. After all desired patients are displayed, click Next.
The wizard will take the user to the Charges screen where they can filter for charges based on the billing form: HCFA, UB, or Invoice. The user should keep the Thru Service Date the same. Then Click Apply to pull claims for the selected form type.
The charges will then be designated as Billable, Unbillable, or Written off. To view the charges under the tab, click from one tab to another.
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- Billable Tab- Charges that have passed the system edits and are ready to be billed
- Unbillable Tab- Charges that have an error in the patients account that will not pass the system edits to be billed ( under the unbillable tab is an export to Excel, the user can use this function to get a detailed list of charges with error description.)
- Written Off- Charges that were already written off.
Once the user is ready to move forward in the Primary Claims Wizard click Next.
The Primary Claims Wizard will navigate to the Claims Ready to Bill. The claims screen provides information regarding the claims being processed through the Primary Claims Wizard. This screen gives a breakdown of claims by- Financial Classes, Payors, and Provider.
This screen also provides the breakdown of the claims showing the following information.
The claims screen will allow the user to highlight the different claims and preview how the claims will look when billed by clicking Preview claims. The user can also export to Excel.
To bill all the claims, click Bill All. The user can also highlight one or more claims and click Bill Selected.
Once billing is complete, the User can click Previous to select a different form or click Restart Wizard when finished billing all forms.