2. Generate Claims (ecs, hcfa)
2.1. Introduction: Claims and Partner
Submitting insurance claims from Partner is fast and easy. You can run preptags, ECS, and hcfa in just a few minutes. You can submit claims at any time. Many practices send electronic claims daily and print those claims needing paper HCFAs once a week.
Read the quickstart procedure below to learn how to send out claims from Partner. Then read further to learn more about the process, including how the claim is created and special features of the hcfa program.
2.2. Quickstart: Submit Claims
Follow this procedure to send your claims out from your office:
Run preptags
You can find the preptags program in the Electronic Claims section of the Billing Functions window in Partner Programs. You can also run it from a command prompt.
Watch for On-Screen Errors and Problems With Your Claims
As preptags runs, it will sort your claims. Claims that need to be printed will be placed in a paper batch for later printing by the hcfa program.
preptags will also verify that all of the patient and account claim information is available. If something is missing, you will see an error message on the screen:
In the example above, the patient's birthdate is missing. You should press [F6 -- Patient Editor], enter the patient's birthdate, and then press F1 to save and continue.
Press [F3 -- Ignore Error] to skip the problem and continue claim processing.
If you ignore the error, the claim's tag will be discarded. It will appear on a Bad Claims report and you will need to fix the problem and rebatch the claim in oops. If you do not fix and rebatch the claim, you will never receive reimbursement for the charge.
Review the preptags/tagsplit Bad Claims Report
Once preptags is finished, a report will print out of your default printer. It lists any claims that had errors you did not fix. To learn more about this and other electronic claims reports, read Review Electronic Claim Submission Reports. You should fix each error listed, rebatch the claim, and then re-run preptags.
Run ECS (This Step May Be Automated)
You can launch the ECS program from the same Partner window as preptags, or type ECS at a command prompt.
For most offices, ECS will run automatically when preptags finishes. You will see a message telling you that:
This completes the electronic claims error checking (preptags) process. Next, I'll run the `ECS' program so you may submit the queued claims. On the following screen you may choose <F2> to select individual claim batches or <F3> to select all available (recommended). Once selected, press <F1> to process and submit. Press <enter> to continueSelect Batches to Send
ECS will present you with the following screen:
Press [F3 -- Select All] and then press [F1 -- Process] to send all prepared claims.
Once ECS finishes processing all the claims, the program will quit. Your actual submission might occur later if your modem is busy. Even if your modem and internet connection are currently down, Partner will keep trying to submit your claims until your connection becomes available again.
Run hcfa to Print Paper Claims
You can run HCFA from the Insurance Billing section of your Partner Windows or by typing hcfa at a command prompt. Claims that could not be sent electronically will be waiting in hcfa in a paper batch. You can run hcfa at any time, select the batch(es) you wish to print, and generate paper HCFA forms.
Read Incoming ECS Reports
Several different reports will be sent to your practice as your claims move from your office to PCC, to the claim clearing-house, and finally to the insurance carrier. Read the EDI Reports manual to learn how to read your reports. Many reports show claim errors and should be reviewed carefully:
Capario (ProxyMed) Daily Verification Report
Capario (ProxyMed) Payor Response Report
RelayHealth (McKesson) Exclusion Claims Report
RelayHealth (McKesson) Carrier Acknowledgement Report
A copy of each report is stored in the ecsreports program for later viewing.
In most situations, the above procedure covers everything you need to successfully submit your insurance claims. Read below to learn more about how insurance claims are created and special features and options of the hcfa program.
2.3. How is a Claim First Created, and Where Does it Go?
Posting a charge in chuck is the first step to creating a claim. chuck creates 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.
2.4. Paper HCFAs: Details of the hcfa Program
Hopefully most of your claims are submitted electronically. Some claims must still be printed on paper, however. The procedure above provides the basics. This section describes additional details and options in the hcfa program.
2.4.1. What Claims Require a Paper HCFA 1500 Form?
Secondary Claims require a copy of the EOB from the primary payor, and therefore can not be submitted electronically in most cases. You will need to print out the claim and staple a copy of the EOB to it.
Charges posted to non-"Real" providers. This generally includes the "Office" provider and Nurse Practitioners. Speak with PCC Support for help configuring which providers are valid for electronic submission. You should inform PCC Support whenever you add a new provider so they can be configured properly for claim submission.
Claims containing "E" diagnosis codes. These codes indicate an emergency visit. Since they generally require additional paperwork, they are automatically sent to a paper batch.
2.4.2. Generating HCFA 1500 Forms
You can print single paper claims from chuck, pip, or oops. Run the hcfa program to print an entire batch of paper claims.
| Do you need to recreate an entire batch of old, previously submitted claims? Read the Resubmit HCFA Forms (maketags) manual. |
When you run hcfa, you are first presented with a list of batches:
On this screen, you can review the number of waiting claims, the date the batch was last printed, and the name of each batch. As described in the procedure above, you can select any batch and press Enter to begin printing.
Is that the Number of Claims that Should Print? The number of claims in this list does not represent the exact number of claims waiting to be printed. It represents the number of tags waiting to be processed. When you select a batch and press Enter, Partner processes the claims and may discover that some of the claims no longer exist. The charges may have been printed and submitted separately, they may have been deleted, or you may have corrected and rebatched charge information (creating an uneeded duplicate tag).
What are the "Z_ECS" Lines for? The hcfa program can generate paper claims for any set of tags waiting to be submitted. You can even print out claims that are supposed to be submitted electronically by selecting one of the "Z_ECS" lines listed in hcfa. This is not recommended and should only be done in an emergency (i.e., your internet connection and modem are down and a timely filing limit is approaching). Even then, it is probably preferable to run oops and print needed claims one at a time.
2.4.3. Features and Options While Printing Claims
As hcfa runs, you will see a number of messages on the screen as the claims are generated:
Claims are Prepared and Listed. hcfa will process all of the tags waiting in the batch you chose. You will see a message listing the claims:
I am getting ready to process the claims. I am now processing the claims. Flinstone, Pebbles 07/01/04 $ 50.00 B MEDICAID Flinstone, Bam Bam 04/02/04 $ 50.00 C MEDICAID Canning, John 03/03/04 $ 26.00 C MEDICAID I am done processing the claims, and am ready to print them.Print a Test HCFA 1500? Next, hcfa gives you the option of printing a sample form to make sure your paper is properly aligned. This is especially important if you print HCFA 1500 forms on an Okidata or other pin-fed printer.
I can print a test form for you, so that you can check the alignment of the paper. Do you want a test MEDICAID form printed (yes or no)? Yes Do you want another test MEDICAID printed (yes or no):You can print as many test forms as you need.
Final Confirmation to Print. The hcfa program double-checks that you are ready to print your claims. You can type "No" and then follow the prompts to quit, or type "Yes" to print out your claims.
I am all ready to print these MEDICAID forms. Are you? If you say yes, I will print them, otherwise I won't:Confirm Successful Printing. In case there was an error while printing, hcfa asks if the claims printed successfully. You should wait until the claims finish printing and review them before answering "Yes" to this question.
Here Goes... I am printing the forms. Are you satisfied with the MEDICAID forms printed? If you are, I shall clear out the queue for this type of form. If you are not, I will give you another chance to print them. Are you satisfied with the MEDICAID forms?Print a Log of HCFA Forms. A log of all the HCFAs generated will automatically print out when you quit the HCFA program.
Reprinting Batches. Partner stores a record of the last printing of each HCFA Batch so you can easily reprint it. At the bottom of the list of batches, you will find options to reprint the last run of each batch:
If you need just a log of the last batch printed, but do not need to print the batch itself, simply select the "Reprint..." option for the needed log, and then answer "No" to the subsequent questions (do not print any claims). Upon quitting the hcfa program, the log will reprint.