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 submits claims electronically. In unusual circumstances, you may need to print some 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. Later, you can use other PCC tools to correct rejected claims.

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.

Work on Outstanding Claims

While the above steps should ensure that every claim is accounted for, you can use PCC’s reporting features to track your accounts receivable and follow-up on old unpaid claims and ongoing problems with payors.

PCC includes hundreds of customizable reports. For working on old insurance A/R, PCC recommends you use the Insurance Accounts Receivable Summary (insaging) report for an overview, and then use the Insurance Accounts Receivable Detail (inscoar) report to analyze specific claims based on insurance company, provider, or other criteria.

Work on Outstanding Claims

Correct Mistakes 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 a charge and recreate the claim. For example, if you find the account has a new insurance plan or was responsible for a larger copay, you can use the Correct Mistakes (oops) program to change the details of the charge and then re-batch the claim to the new payer. In rare cases, you might use the maketags program to re-prepare a large batch of claims based on a date range, a provider, or other criteria.

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 a paper 1500 HCFA form.
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.
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 and Rejections
After you prepare and submit claims, you must deal with claims that could not be submitted or were rejected.
Claim Error Needs Correction 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?

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