Billing Automation is comprised of the following features that were designed to increase the efficiency of collecting and posting payments from Clients and Payers:
- Invoice Creation
- Invoice Processing
- Claims Submission
- ERA Processing
- The manual invoice creation, processing and claim submission processes are being automated to reduce the amount of time required for Organizations to collect payments for the services rendered. After enabling each feature, Organizations can configure exclusion rules based on their individual requirements to prevent specific invoices and claims from being created, processed and/or submitted automatically.
- The current ERA Processing feature is being enhanced to add the ability to configure rules that determine how all ERAs are posted based on their Reason Codes.
How do I enable the Billing Automation Features?
- The Billing Automation Features can be enabled within the Organization > Claims Service > Automation Settings page.
- Enabling the toggle associated with each Automation will turn on that specific feature.
Do I have to enable all of the Billing Automation Features?
- Each automation can be enabled and utilized individually to cater to the Organization's needs; there is no requirement to enable all three automated workflows.
What happens after I enable the Billing Automation Features?
- Invoice Creation - A nightly process will automate the creation of invoices for unbilled sessions that are present within the Billing > Batch Invoicing > Create New Invoices queue starting on the date the automation is enabled.
- Invoice Processing - A nightly process will automate the processing of invoices that are present within the Billing > Batch Invoicing > Process Existing Invoices queue to the Claims Awaiting Submission queue starting on the date the automation is enabled.
- Claims Submission - A nightly process will automate the submission of claims in the Billing > Claims > Awaiting Submission queue to the clearinghouse starting on the date the automation is enabled.
- ERA Processing - ERAs that are received are automatically processed to post according to their associated Reason Codes.
Can rules be configured to prevent Invoices and Claims from being created, processed, and submitted?
- Each Organization can configure exclusion rules based on their individual requirements to prevent specific invoices and claims from being created, processed, and/or submitted automatically.
- For example, if an Organization needs to prevent all Claims for a specific Payer from being submitted automatically or would only like Invoices to be automatically created for unbilled sessions that have a signed Progress Note, rules can be configured to adhere to the requirements of these scenarios.
- The exclusion rules can be configured for each automation independently, giving Organizations granular control over the workflows they choose to automate.
Will any default ERA Processing Posting rules be applied after enabling the automation?
- Yes, the following ERA Posting Rules will be populated by default after enabling ERA Processing Automation:
- For All Insurers, CO-45, post as Write Off
- For All Insurers, CO-253, post as Write Off
- For All Insurers, PR-1, post as Patient Responsibility
- For All Insurers, PR-2, post as Patient Responsibility
- For All Insurers, PR-3, post as Patient Responsibility
- In addition to the pre-populated Posting Rules, all ERAs with codes that do not have Posting Rules configured will not be auto-populated by default.
Are there any additional fees to utilize the Billing Automation Features?
- There are no additional fees associated with utilizing the Billing Automation Features.
Are Claims still scrubbed when utilizing Automated Claims Submission?
- Yes, the Automated Claims Submission feature will process each claim through the Claim Scrubber for validation before they are submitted to payers. Any Claims that do not contain errors will be submitted automatically to their respective Payers. If there are any Claims present that contain errors, they will be flagged in the Claims Awaiting Submission grid and will not be submitted to their respective Payers.