When your practice needs to prevent certain claims from being submitted, you can create a claim hold. A claim hold prevents claims from going out for specific dates of service, billing providers, places of service, and insurance plans.
Coming in PCC 9.4: The features described below will arrive in PCC 9.4, coming to all practices in the third quarter of 2022.
Watch a Video: You can watch a video to learn about Claim Holds.
Review Your Existing Claim Holds
Open the Claim Holds tool from the Tools menu in PCC EHR.
Your practice can use User Roles to specify which users can open the tool. (See Set User Roles for Permissions and Security)
Click on an existing claim hold in the Claim Hold Index to view details.
Legacy Claim Holds: Prior to PCC 9.4 (released in the 3rd quarter of 2022), PCC Support created claim holds upon request, using your system’s underlying claim configuration. Those holds will not be visible in the Claim Holds tool. PCC can help you migrate holds into the new Claims Hold tool so your practice can manage them directly. Contact PCC Support for assistance.
Create a New Claim Hold
Follow the procedure below to create a new claim hold.
Open the Claim Holds Tool
To create a new claim hold, click “Add”.
Enter a Description and Dates of Service
A claim hold requires a description and a date range for dates of service.
Description: You can include a lengthy description indicating the purpose of the claim hold.
Dates of Service: Enter the claim hold date range. Claims for these dates of service, including the start and end date, will be held until the hold is deleted or changed.
Select Billing Providers, Places of Service, and Insurance Plans
Select additional optional criteria for the new claim hold. You can restrict a claim hold to specific billing providers, places of service, and/or a subset of insurance plans to which your practice bills.
Billing Providers: Click “Edit” to select which providers’ claims will be held. When processing claims, PCC will hold claims with a Billing Provider that matches one of the providers listed in the claim hold.
Places of Service: Click “Edit” to select which locations’ claims will be held. You can select one or more places of service. When processing claims, PCC will hold claims with a Billing Location that matches places of service listed in the claim hold.
Insurance Plans: Click “Edit” to select which insurance plans’ claims will be held. You can search and sort by plan name, plan group, or the payor id used for electronic submission.
When making a selection, you can search a list and use “Select All” and “Select None” to quickly pick groups of providers, locations, or plans.
Click “Save” to finish creating the claim hold.
Holds are immediately active. After you create a hold, any claims that match the specified dates of service, providers, locations, and insurance plans will not be sent out when you process claims.
When Does a Claim Hold Expire? Never: Claim holds are based on dates of service, so they never expire. Any claims that match the indicated dates of service and the other criteria for the hold will never be sent. In order to release held claims, you must either delete the hold or edit the dates of service or other criteria to change which claims are held.
Edit or Delete a Claim Hold
Select a claim hold and click “Edit” to make changes.
For example, you may have a claim hold for a new clinician which holds claims for all insurance plans. As they become credentialed with each payor, you can edit the claim hold and make changes to the insurance plan criteria. Doing so will release claims that do not match the new criteria.
Select a claim hold and click “Delete” to delete a claim hold.
The next time you process and submit claims, any claims held by the deleted hold will be processed and sent.
Configure User Access to the Claim Holds Tool
Your practice can designate which user roles will have access to the new Claim Holds tool.
User the Roles tab on the User Administration tool to edit an appropriate role.
Next, review that appropriate users are assigned that role.