Insurance Billing Overview

Partner’s insurance billing tools help submit claims, review rejections, and work down your insurance accounts receivable. Partner helps you maximize the use of your time as you pursue proper insurance reimbursement.

You can break the task of collecting insurance balances into five simple steps:

Generate and Submit Claims

Use Partner’s preptags, ECS and hcfa programs to generate claims. As claims are created and PCC “scrubs” your claims, watch for warning messages about incomplete patient or account information.

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Read EDI Reports to Verify Claim Submission

You will receive electronic reports detailing your claim submissions, including logs of any errors or submission problems. Your office should use e-mail and the ecsreports program to review “Bad Claims” and “Payor Response” reports. Understanding all of the different reports will give you more tools for dealing with an unpaid claim. All electronic reports (whether they are printed or sent to your e-mail box) are stored in the ecsreports program for easy access.

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Work Outstanding Claims

Use Partner’s reporting features to track your accounts receivable and follow-up on old claims. While Partner has hundreds of reports, a good place to start is the “Insurance Accounts Receivable Summary” (insaging) report. It provides an overview, by insurance group, of your outstanding balances. You can then use the “Insurance Accounts Receivable Detail” (inscoar) report to analyze specific claims based on insurance company, provider, or other criteria, and contact the carrier about unpaid claims.

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

When you receive ERAs or EOBs, post the payments and adjustments in the Autopost and Post Insurance Payments programs (autopip, pip). Post the payment information and link payments and adjustments to each of the referenced charges. When you post a $0 payment, or payments and adjustments that do not cover the full amount of the charge, you can use pip to fix account problems and resubmit the charges, send them to a secondary policy, or bill the family.

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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. In rare cases, you can use the maketags program to re-prepare a large batch of claims based on a date range, a provider, or other criteria.

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  • Last modified: April 2, 2021