Submit Claims

Follow this procedure to prepare and send claims to insurance companies and other payers.

Run Prepare/Submit Electronic Claims (preptags/ECS)

You can find Prepare/Submit Electronic Claims (preptags/ECS) in the Electronic Claims section of the Billing Functions window in the Practice Management window.

Watch for On-Screen Errors and Problems With Your Claims

As PCC processes your claims, it will list activity on the screen and sort claims into batches. For example, claims that need to be printed will be placed in a paper batch for later printing by the hcfa program.

PCC will also scrub your claims, which means checking claim information against standards required by payers. For example, it will check to see that demographics and insurance policy information are valid.

For some types of claim errors, PCC will display an error message on the screen, and provide an interface for you to fix the problem:

In the example above, the patient’s birth date is missing. You should press F6Patient Editor, enter the patient’s birth date, and then press F1 to save and continue.

Press F3Ignore Error to skip the problem and continue claim processing.

What Happens if I Ignore an Error?: If you ignore an error, it will appear later on the Bad Claims report. You can fix the problem, regenerate the claim, and run your claims again. If you do not fix problems on the Bad Claim report and regenerate the claim, your claim will never be submitted, and you will not receive payment for the charges.

Review the Bad Claims Report

Once PCC is finished processing your claims, it will ask to print the Bad Claims report to your default printer. You can print it so you have a physical copy, or retrieve it later in the ecsreports program.

To learn more about this and other electronic claims reports, read Review Electronic Claim Submission Reports.

You should fix each error on the report, regenerate the claim in oops, and then re-run your claims. If you do not correct an error on the Bad Claims report, a claim will never be submitted and you will not receive payment for the charges.

PCC Runs the ECS Program

After claims are processed, PCC automatically runs the ECS program, which formats and submits your claims. Depending on your practice’s configuration, this may run without options, or you may see a list of payer batches on the screen.

Optionally Select All or Some Batches to Send

If ECS presents you with a list of batches, you can select all batches or pick individual batches to submit.

Press F3Select All and then press F1Process to send all prepared claims.

Note: Once ECS finishes processing claims, the program will quit. Your actual submission might occur later if your internet connection is down. Your PCC system will continue trying to submit your claims until your connection becomes available again.

Run hcfa to Print Any Remaining Paper Claims

You can run the hcfa program from the Insurance Billing section of your Practice Management window. Claims that could not be sent electronically will be waiting in hcfa in a paper batch. You can run hcfa at any time, select the batch(es) you wish to print, and generate paper HCFA forms.

Read Incoming ECS Reports

Several different reports will be sent to your practice as your claims move from your office to PCC, to a claim clearinghouse, and finally to the payer. Many reports show claim errors and should be reviewed carefully.

  • preptags/tagsplit Bad Claims: Your system creates this report as it processes claims. It includes errors PCC found in your claims before they even left your system. You should review each one, correct the error in the patient’s account, regenerate a new claim, and submit your claims again.

  • PCC Daily Submission Summary: This report comes from PCC’s central claim hub. It confirms that your claim successfully traveled from your system to PCC.

  • Payer and Clearinghouse Acknowledgement Reports: These reports indicate that the payer or clearinghouse received your claims.

  • Payer and Clearinghouse Error Reports: These reports contain rejections and errors that the payer or clearinghouse found on your claims. You must review and correct these errors. Most practices have a biller who runs the Claim Error Report in srs each day in order to address all payer and claim error responses.

Note: A copy of each report is stored in the ecsreports program for later viewing, and some reports are automatically parsed and added to the account’s history so you can read what happened to a claim in the Correct Mistakes (oops) program.

In most situations, the above procedure covers everything you need to successfully submit your insurance claims. Read articles from the list below to learn more about how insurance claims are created and special features and options.

  • Last modified: February 24, 2022