EDI Review, Approval and Submission:
This procedure is to examine each encounter that a therapist submits for errors. This is also the stage at which a billing technician will need to alter fees in the superbill in accordance with patient account alerts that are posted.
EDI Reviews are conducted daily.
Manual 1500 Submissions:
For non-electronic submission out of network payers, CMS 1500 forms must be printed and mailed. These will be completed the same day as EDI claim submission.
After the encounter has been approved, a billing tech may locate paper claims to be printed by going to the “encounters” tab and “Track claim status”. Modify the search window to “Ready to Print Paper Claims”. Process each one individually and print the form by right clicking on the claim line and selecting print paper claim.
Paper 1500 claims will be mailed the same day as they are printed.
Instructions:
The workflow for electronic submissions is as follows:
· Items appear under the “Find Encounter” menu.
· Items in the “Draft” tab are in need of review and approval.
o Open each item in the tab.
o In the Batch line item enter the date, tech initials and client code.
o Review each item for coding, fee adjustment and any other errors.
o Review the insurance case applied, ensure that it is proper
o If a no-show bill is found the insurance case should be “self-pay”
o Self-pay items should have the “Do not submit electronically” box marked.
· After reviewing all items and approving each (individually or as a group) prepare to submit them.
· Under the “encounters” tab select “submit electronic claims”.