Billing

• Manage Claims
• Billing Claims
• Reconcile Payments / ERA, Reconcile 835/ EOB and EDI File Log

Manage Claims

The Manage Claims option includes data like Processed Claims, Rejected, Acknowledged and Transmitted claims in the system.

View Claim Status

Billing >> Manage Claims

The user can view the claim status by using the option Manage Claims.

For searching the Batch Status, update the Batch ID, Patient Name, Payor, Start Date and End Date and click Search option.

Billing Claims

Billing claims are formal documents submitted to insurance companies and seeking reimbursement for medical services delivered to patients in their homes. These claims detail the services provided, associated costs, and ensure proper compensation for home-based services.

Adding Batch for Billing

Billing >> Billing Claims

To bill the visits in the Timesheet, the user has to create Batches for the Timesheet and submit them to the insurance company for payment.

Click +Add Batch option on the top right side of the screen. Select the Batch Type as Initial Submission, Select the Payor, Service code, Start Date, End Date and Click Search option. Now a popup will appear with the details of the Timesheet, check the box and Click Create Batch option for adding a Batch.

The Batch is created with initial submission. Now under Actions Click the Submit Claim option.

Once the Batch is submitted, a green color mark appears on the Batch number to indicate that the Batch is submitted.

Resubmission of Batches

Billing >> Billing Claims

For Resubmission of Claims follow these steps:

• Select the Batch by using the check box.
• Click Bulk Action - Mark As option in the screen.
• Select Replacement option.

Now click Add Batch option and Select the Batch Type as Adjustment (Void/Replace)Submission and update the Payor Name, Start Date, End Date and Click Search option.

The following screen appears with the Line item. Select the line item and click create Batch option.

The Batch has been created for Adjustment (Void / Replace)Submission. Select the check box and click Submit claim option.

 

 

Reconcile Payments / ERA, Reconcile 835/ EOB and EDI File Log

Reconcile Payments / ERA

Reconcile payments refers to the process of comparing received payments from insurance providers and patients against the billed charges for services provided. This ensures accuracy, identifies discrepancies, and helps resolve outstanding balances, contributing to the financial stability of the home health care agency. Electronic Remittance Advice, which is an electronic document that provides detailed information about payment and denial of claims.

Get Latest ERA

Billing >> Reconcile Payments / ERA

Click the option Latest ERA. The following screen appears, click Get Latest ERA option. The latest ERA details will be displayed on the screen.

Reconcile 835/ EOB

Reconcile 835/ EOB helps home healthcare providers to verify that payments and denials on the EOB are consistent with the ERA, ensuring accurate financial management and claims processing.

Billing >> Reconcile 835/EOB

Update the required fields and click Search option. The details will appear on the screen with Patient name and Billed amount.

EDI File Log

An EDI (Electronic Data Interchange) file log is a record of digital interactions between healthcare providers, payers, and agencies. It tracks the exchange of patient data, claims, and billing information, ensuring compliance with industry standards and facilitating efficient communication for better patient care and reimbursement.

Billing >> EDI File Log

The list of EDI File logs information is displayed in the screen. Enter the File Name, File type and click Search option to view the required EDI File.