Insurance Billing Overview

PCC’s insurance billing tools help you process and prepare claims, send them electronically or print them, review rejections and denials, fix problems and resubmit, and work down your insurance accounts receivable. You can maximize the use of your time as you pursue proper payment.

Learn All Steps for the Biller Role: For a complete guide for billers, see New User Training for Billers. You can use that outline to learn how to complete all billing tasks in PCC EHR.

Here’s an overview of the insurance billing process with PCC:

Ensure All Charges Are Posted

Before you bill insurance, your practice can use PCC’s tools to post charges and then review that all charges were posted.

Generate and Submit Claims

Next, your practice processes and submits claims.

Process and Submit Claims

Work on Claims that Can’t Be Sent or Were Rejected

As you process your claims, your PCC system checks for errors that prevent claims from being sent. You can work on those claims inside the Claims tool. If the payor responds with a rejection, you can review the rejection reason, correct the problem, and queue up a new claim.

Work on Claim Errors and Rejections

Post Insurance Payments and Adjustment (and Submit Remaining Charges to the Next Responsible Party)

When your practice receives ERAs and EOBs from payors, you can automatically post most payments and adjustments and then manually post any that need your attention. When payments and adjustments do not cover the full amount of a charge, or the payer sends an unusual adjustment or denial, you can fix account problems and resubmit the charges, send them to a secondary policy, or bill the family.

Post Insurance Payments

Work on Outstanding Claims

While the above steps should ensure that every claim is accounted for, your practice also needs to track accounts receivable and follow-up on old unpaid claims and ongoing problems with payors.

Follow Up on Unpaid Encounters with Insurance Balances

Edit Encounter Details and Recreate Claims

During any of the above steps, or even before you first submit a claim, you may need to fix a problem with an encounter’s charges or claim information and queue up a new claim.

Edit Encounter Charges and Claim Information and Resubmit a Claim

Here are some related articles in Billing and Practice Management > Bill Insurance:

Read EDI Responses to Claim Submissions
Your practices receives many different electronic responses to claim submissions and billing. Read this article to learn the different EDI responses, which responses require attention, and how to use PCC's tools to review and respond.
Submit Claims
Use the Claims tool to process and submit claims to insurance companies and other payers, work on claims that could not be submitted, and review a log of submissions.
Review Archived EDI Reports
After you submit claims, your practice will receive clearinghouse and payor acknowledgements as well as ERAs and other electronic notifications from PCC, claim clearinghouses, and payors. You can use tools in PCC EHR to review these responses. When you need to do deeper research, you can use the EDI Reports (ecsreports) program.
Print Paper HCFA Claim Forms
While most claims are transmitted to payors electronically, sometimes you may need to generate paper 1500 HCFA forms, or print a single paper claim.
The Claim Journey Explained
How is a claim created, and what happens in the background to make sure your practice is paid? Read below to learn some of the "under the hood" workings of claims after you post charges into PCC EHR.
Edit the Insurance Plans On Your PCC System
Use the Tables tool in the Configuration menu in PCC EHR to update the list of plans that your practice bills.
Add an Attachment Code to a Claim
If a secondary insurance requires the EOB from the primary, or any claim requires a certificate of medical necessity, discharge summary, or other clinical documentation, you need to send an attachment to the payor. You can edit the encounter and add an attachment code to an encounter, generate a unique attachment ID, and specify the attachment type and method. Attachment information will then be sent with the electronic claim.
Configure Capitation and Capitated Plans
Capitation payments are not like other income. How should you configure PCC EHR in order to track payments you receive as part of your participation with a capitation insurance plan? PCC Support will complete the steps in this article for you, but you may find the instructions helpful if you are a system administrator or practice manager and make updates to your PCC tables.
Edit the Insurance Plans on Your PCC System
Use the Tables tool in PCC EHR to add a new insurance plan and configure the payors you send claims to.
Submit Claims
Prepare and submit claims. Then work on any claims that were stuck and couldn't be submitted.
Configure Claim Holds and Claim Delay
Watch this video to learn how to hold claims for specific providers, locations, or plans and how to configure your practice's claim delay.
Configure Claim Holds and Claim Delay
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. You can also configure your practice’s claim delay, which prevents any claim from going out until a certain number of days after the date of service.
Work on Claim Errors, Rejections, and All Unpaid Claims
After you prepare and submit claims, you must deal with claims that could not be submitted or were rejected.
Claim Processing and Needs Correction Error Reference
What kinds of pre-submission processing does your PCC system do on claims? What errors can it find, and how do you fix them?
Track Newborn Charges and Delay Billing the Family
If you bill for newborn encounters before the family has updated their insurance, will your PCC system send them a large bill? Your practice can add a newborn patient to your PCC system, track newborn hospital and office encounters, and delay billing until the family has updated their insurance information. Read below to learn more.
Respond to Claim Rejections
If unaddressed, rejected claims result in lost revenue. Use the Rejected Claims worklist to review and respond to every claim rejection sent to your practice.
Respond to Claim Rejections
If unaddressed, rejected claims result in lost revenue. Use the Rejected Claims worklist in the Insurance Balances tool to review and respond to every claim rejection sent to your practice.

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