PERMISSIONS REQUIRED: You must have Billing Permissions with the ability to "Submit Claims to Clearinghouse" enabled.
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Before You Begin
In order to Submit Electronic Claims, ensure the following:
- Must be connected to Ensora Clearinghouse
- Your Client's Insurance Billing Information is setup.
- Client Progress Note for Appointments MUST have a Diagnosis Code in the Note.
- An appointment is created with Service Type(s) included.
NOTE: When multiple service types are included on the appointment, each service type is included on the claim.
- An Invoice is created for the Appointment. You can only generate Claims from Invoices.
Submitting the Claim
There are three steps to Submit Electronic Claim:
- Create the Invoice.
- Add the Invoice to Awaiting Submission - The Invoice becomes a Claim and sits in the Awaiting Submission queue.
- While you Claims are Awaiting Submission, you can perform a general Claim scrub. Claims can be checked for common errors such as Date of Birth, Gender, Address, Diagnostic Code, etc. If a Claim has no errors can be submitted to Ensora Clearinghouse.
- Claim is submitted to Ensora Clearinghouse. Here is is check again for errors. All Submitted Claims are sent to Ensora Clearinghouse each business day at 4:30p CST.
Add Claim to Claims Awaiting Submission
- Locate Invoice on the Client Ledger.
- Click Actions button and select Add to Claims Awaiting Submission.
NOTE: When multiple service types are included on the appointment, each service type is included on the claim.
Check Claims for Errors & Submit Claim
Checking for errors is a simple scrub that checks for missing items such as address, birthdate, Provider, etc. It will not validate that information entered is correct, it is simply searching for missing information.
- Click Billing tab in primary navigation bar. Claims > Awaiting Submission tab displays.
- Select checkboxes for Claims you wish to check.
- Click Check Select Claims for Errors button above.
- Fix prompted errors.
- Select appropriate Claims and click Submit Select Claims button.
- Claims will now display in the Submitted tab.
Appointments with Multiple Service Types
When an appointment contains multiple service types they are all submitted on a single claim.
- An appointment is created with one or more service types included.
- An invoice is created for the appointment and includes both service types.
- The claim is added to awaiting submission and both service types are included on the CMS 1500 for the claim.