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.
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.