Create New Claims and Resubmit (maketags)

When a clearinghouse fails to process and acknowledge your claims, or claims for a specific payor or date range fail, you may need to create and submit new claims for a large number of encounters. You can use PCC’s under-the-hood Resubmit Claims (maketags) program to queue up new claims for encounters.

Maketags is a Power Tool: Only use maketags in those rare cases when you need to resubmit a large number of claims based on a date of service or other criteria. You can create a new claim for any single encounter from the Correct Mistakes (oops) program (see Resubmit a Claim).

Video: Watch Create New Claims and Resubmit to learn more.

Sample Problems for maketags

Why would you need to find and resubmit a large batch of claims?

• You have used the wrong tax ID number for the last three weeks of claim submissions. You received the rejections, you corrected your tax ID, and now you need to resubmit every claim from the last three weeks.
• You have been working with an insurance company that has denied claims improperly. They have asked you to resubmit all claims for visits by their patients between January and October of last year.
• You have billed a procedure using the wrong procedure code. After you correct the code in your practice’s Table Editor (ted), you need to find every claim that had this procedure code and resubmit.
• You submitted claims to a claim clearinghouse or payor, but never received an acknowledgement or response.

Use the Correct Mistakes (oops) program to resubmit single claims. Use maketags to queue up claims for a large number of encounters.

Find Encounters and Create New Claims (Basic)

Follow the procedure below to create new claims for encounters.

Have You Fixed the Problem?: The maketags program is powerful, but it does not address outstanding billing problems and will not increase revenue. Before you run maketags to create new claims, you should understand why claims were rejected (or need correction) and adjust your configuration or use other PCC tools to work on unpaid claims. Contact PCC for help.

Find Encounters and Create New Claims (Advanced)

Do you need to resubmit all claims with a certain billing status, procedure, place of service, or for accounts with a specific status flag? Use the “Restrict with SRS” function to create more detailed custom restrictions.

Override Criteria: When you use the “Restrict with SRS” function, all of the criteria you specify on the first screen will be overridden by the advanced restriction options you select using the SRS screens as described below.

Follow the procedure below to create new claims for encounters based on SRS criteria options.

Save Frequently Used Criteria: As with other srs-based reports, maketags criteria can be saved and reused. If you commonly rebatch claims for one particular insurance or procedure, for example, you may want to save the detailed report criteria you entered and restore it the next time you need to resubmit claims. After entering your criteria the first time, press F5 – Save Rpt Criteria on the summary screen. When you next need that same criteria, press F8 – Restore Criteria from the first srs criteria screen.

Resubmit Claims Criteria Reference

Read below to learn more details about the criteria options shown on the first screen in the Resubmit Claims (maketags) tool.

SRS Reporting Ignores These Criteria: If you use F5 – Restrict with SRS, the criteria options in this reference will be ignored.

Rebatch Charges by Age or Date Range

Use the “Age of Charges” options to select charges of a certain age. You can enter an age range, in days, using one of the top two options. Or, you can input a specific date range.

Rebatch Charges by Paid and Insurance Status

Under most circumstances, you only want to recreate claims if they are unpaid and still pending an insurance company. You may occasionally need to create batches for an entire insurance company, regardless of whether or not there is an outstanding balance. Use these settings to select which charges, based on pending and paid statuses, maketags will batch:

Rebatch Charges by Insurance Plan

If you select “Just One Plan,” you can choose the insurance plan of the claims you wish to resubmit on the first screen:

If you leave the default of “Many Plans” selected, however, maketags will ask you to select the insurance plan or plans when you press

.

Press Page Down, Page Up, or the up and down arrow keys to select the desired plan and press F2 – Select to mark it. If you want to submit claims from all insurance plans, press F3 – Select All.
Press F1 – Process after you have selected all the needed plans.

Use Groups: Select the “Group” heading at the top of a list of plans to select the entire group. You can also press F5 – List By Group to view all of your insurance groups. By selecting groups instead of individual plans, you can very quickly pick out the different insurance companies whose claims you need to resubmit.

List By Pattern: Press F6 – List By Pattern to search for a word or number, such as “Aetna” or a PO Box number. You can then select plans from the list of results.

Rebatch Charges by Provider

You can sort and resubmit charges for all providers or for specific providers. This comes in handy if you use the wrong provider ID# for a period of time and you need to resubmit all the claims from that time.
Change the “All Providers” field to “No” and press F1 – Generate Report to select a specific provider.

On the provider selection screen, use the arrow keys and press F2 – Select to pick providers or provider groups. Then press F1 – Process to continue.