The Claims Journey Explained

Posting a charge in checkout is the first step to creating a claim. The Checkout program creates claim tags, which are records of charge information. Other programs, such as oops or pip also create tags when you rebatch charges or send them to the next responsible party.

How do you transform the tags on your system into claims? Either by running preptags followed by ECS or by running hcfa.

hcfa is a simple program that prints paper HCFA claims for any batch (a batch is a collection of tags). When you run preptags, however, Partner sorts the tags, checks for errors, puts designated tags into a paper batch, and then launches ECS to send electronic claims to PCC for processing.

If you have any questions or would like to learn more about how claims are created in your office, feel free to contact PCC at 1-800-722-1082.

Under the Hood Vocabulary: When you speak with PCC’s electronic claims team, you may hear references to preptags, tagsplit, and splitconfig. These are the underlying programs that process claims according to your practice’s customized configuration needs. If you want to know the true nerdy side of what these words mean, the process works like this: The preptags program calls the tagsplit program according to your practice’s settings. The tagsplit program processes queued up tags and sorts them by insurance batch while doing a number of other validation checks, all of which relies on your practice’s custom configuration which is maintained in the splitconfig configuration file. The preptags program then (usually) automatically runs the ecs program, which submits claims to payers.

  • Last modified: July 10, 2019