Read ERA 835s from Payors

You can use PCC's tools to work on claims with errors, rejections, and denials. But what if a problem is fixed, but the claim wasn't resubmitted? Or what if an insurance payor simply never responds? Are some insurance payers regularly failing to pay you in a timely fashion? You may need specialized tools to track and work down your practice’s insurance A/R.

Learn how to submit claims in PCC EHR or in the previous Practice Management tool.

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 insurance reimbursement.

While most claims are transmitted to payors electronically, sometimes you may need to generate a paper 1500 HCFA form.

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.

Every insurance claim in your PCC system has a unique identification number. The number appears in various reports and programs, and you can use it to improve claim tracking and payment posting.

Sometimes a credit should be written off and counted as income to your practice. For example, if an account credit or insurance overpayment remains on your books for several years, your practice may decide to write it off and treat it as revenue.

When you need to refund a personal credit to a family, you can post a refund adjustment.

From time to time, insurance companies will ask you to reimburse them for an overpayment. Sometimes, the company will ask you to send them a refund check. Sometimes, they will underpay you for more recent charges in order to make up for the overpayment on an old charge.

When insurance carriers send payment and adjustment information, either on an EOB or an ERA, they often include a code with a small message. These codes are known as CARC values, or Claim Adjustment Reason Codes, and they are an industry-wide standard.

When a check bounces, or a credit card payment is stopped, you can quickly reverse the payment in the Payments tool in PCC EHR. You can optionally post a fee, in accordance with your office's financial policy.

Learn how to post personal payments in PCC. When a family pays their bill, you can enter their payment, link it to charges, and optionally enter account notes.

The medical biller's job would be easier if accounts paid on time and insurance companies reimbursed the correct amount. Unfortunately, accounts build up balances and credits and insurance companies overpay, underpay, and demand "takebacks."

After a payer reviews your electronic claim, they will send your practice an explanation of what charges are paid, adjusted, or denied. On paper, this information arrives as an Explanation of Benefits (EOB) and a check. The electronic version of an EOB is called an Electronic Remittance Advice, or ERA. An ERA usually arrives in coordination with a direct deposit to your practice's bank account. You can use PCC software to post payment and adjustment information from both ERAs and traditional EOBs.

With PCC, you can automatically post most payments and adjustments sent to your practice as an ERA. If a response requires manual attention or you receive a paper EOB, you can manually post the payments and adjustments.

Contents1 Create the Insurance Groups, Plans, Fees, Payment Types, and Accounts to Record and Track Payments2 Post Capitation Payments Capitation payments are not like other income. How should you configure the PCC billing system so you can enter and track capitation payments over time? Read the steps below to learn how to create appropriate insurance […]

You can quickly and easily reconcile payments that your practice has posted in PCC EHR. Run the Payment Reconciliation report in order to prove out, checking against your cash drawer and records at the end of the day or the end of your shift. Open the Payment Reconciliation report from the Report Library in PCC […]

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 review payment history by encounter, or see all payment history for an account. You can also edit payments that were posted incorrectly and adjust how payments are applied to charges. Read below to learn how.

You can print a receipt whenever you post a payment. You can also print a receipt for any payment(s) in an account's history.

After you prepare and submit claims, you must deal with claims that could not be submitted or were rejected.

What kinds of pre-submission processing does your PCC system do on claims? What errors can it find, and how do you fix them?

When you want to write off a charge that is unrecoverable ("bad debt"), or post other account adjustments that reduce the amount due for a charge and decrease an account's outstanding personal balance, use the Payments tool.

Learn how to record capitation checks, incentive payments, insurance interest payments, payment amounts that exceed the amount due on a charge ("Overpayments"), and end-of-year withhold payments

When payors adjudicate a claim, they send your practice an Electronic Remittance Advice (ERA), also known as an 835 file. PCC receives these ERAs and you can review them in the Electronic Remittance Advice tool.