Resubmit Batches of Claims (maketags)
Use Resubmit Claim Forms (maketags) to find and rebatch large groups of claims based on customizable criteria.
You can rebatch and print any single claim, for any charge or visit, from the Correct Mistakes (oops) program (see Resubmit a Claim). Sometimes, however, you need to resubmit all of the claims for a certain insurance group, a specific date range, or all of the claims containing a certain procedure.
Contents
Why would you need to find and resubmit a large batch of claims?
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You have used the wrong tax ID number for the last three weeks of claim submissions. You receive the rejections, you correct the number in Partner, and now you need to resubmit every claim from the last three weeks.
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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.
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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.
Use the Correct Mistakes (oops) program to resubmit single claims. Use the maketags program when you need to resubmit a large number of claims.
You can run maketags and resubmit large batches of charges quickly and easily. Read the procedure below to learn the basics.
Have You Fixed the Problem?: The maketags program is powerful, but it does not address outstanding billing problems and will not increase revenue. Before running maketags for a large set of claims, you should understand why the claims were rejected (or need correction) and adjust your configuration and other Practice Management tools to correct the issue.
Run maketags
Run the maketags program from the Insurance Billing window of the Billing Functions window in your Partner Windows. You can also run it from a UNIX prompt by typing maketags.
Select Search Criteria
Use the on-screen options to tell maketags which charges you need to resubmit, and press F1 – Generate Report. For options such as multiple insurance companies or more than one provider, maketags will ask you to make additional selections after you press F1.
Optional: Review List of Found Claims
Press F8 – Show List to review or print the list of claims that maketags found.
Press F1 – Generate Report to Rebatch the Claims
After the claims are batched, you can submit the claims.
maketags can find and rebatch charges by a wide range of criteria, including age, balance and insurance status, insurance plan, and provider. Read below to learn more about the different criteria you can select from the first screen in maketags.
Combine Criteria for a Complex Search: You can combine several different criteria. For example, you could use the criteria options to tell maketags to resubmit all unpaid charges, either pending or personal, with any Aetna insurance company, that is between 30 and 120 days old.
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
F1 – Generate Report
:
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.
Submit the Whole Visit?
Do you need to resubmit only the unpaid part of a claim, or the entire claim? By default, maketags processes charges individually, based on the restrictions you define on the criteria screen. If only one procedure from a patient’s visit meets the criteria listed, then only that procedure will be re-batched.
You can ask maketags to rebatch the entire date of service instead:
Set the “Include entire visits” option to “Yes.” If maketags finds a qualified charge to process, it will also rebatch all other procedures from that same visit, regardless of whether or not the other charges are due or meet the other criteria.
Use an SRS Report to Find and Rebatch Claims
Have you ever needed to resubmit all claims with a certain procedure, place of service, or for accounts with a specific status flag? Use maketags‘s Smart Report Suite (srs) features to create custom restrictions specifying which charges you would like to rebatch.
Override maketags With SRS Results: When you choose to restrict maketags with srs, all of the criteria you specify on the main screen of maketags will be ignored. You will instead assign your restrictions manually within srs.
Follow the steps below to use an srs report to search for and process claims that need to be resubmitted.
In maketags, Press F5
Press F5 – Restrict with SRS on the main screen of maketags.
Enter Date Range
Enter a transaction date range within which srs should search for charges to resubmit. Press F1 – Generate Report to continue.
Enter Amount Range
The next screen will ask you to specify a “Charge Amount Due” range. The default shown above will include only due charges (those with at least a penny due). Enter any amount range and press F1 – Process.
Select Insurance Plans
Next, specify the insurance plans for which maketags will rebatch claims.
Press F2 – Select to select individual plans, press F5 – List By Group to quickly select an entire insurance company, or select by the pattern of your choice using F6 – List By Pattern. Press F3 – Select All to include all insurances and all personal charges.
Important: Do not select the “Personal” insurance on this screen unless you want all personal charges to be re-batched for submission!
Review Criteria
Finally, review your chosen criteria and specify whether or not you would like to add any other restriction criteria.
If you wish to add more restrictions, such as a procedure or a place of service, press F8 – Add/Edit Criteria. Otherwise, skip to step 8 below.
Optional: Select Additional Criteria
If you chose to add criteria, srs will ask you for the restriction criteria you would like to use. Add as many criteria as you wish. You can use the asterisk (*) symbol to view a list of available criteria.
In the above example, Provider, Procedure, and Place of Service (in addition to the default “Amount Due Per Charge” and “Current Insurance”) have been added. Press F1 – Accept Criteria to continue.
Optional: Select Criteria
For every criteria you added to the list, srs will ask you for specific details. Select your criteria from each screen and press F1 – Accept Criteria to continue. The “CHARGE Amount Due” and “CHARGE Current Insurance” criteria were already selected and processed. You do not have to fill them out again.
In the example above, the user has selected a follow-up hospital procedure group for the “CHARGE Procedure” criteria. Only claims with one of the three codes listed in that group will be collected for re-batching.
Accept Criteria
Once you have added all of your restrictions, press F1 – Accept Criteria to accept your criteria. maketags will gather the charges to rebatch based on the criteria you specified.
Save Frequently Used Criteria: As with other srs 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.
When you generate claims, PCC’s maketags system batches all of the charges it finds based on your criteria. You then submit them using Practice Management’s claim submission tools (See Submit Claims).
Under unusual circumstances, you may need to force a batch of claims to print. If you need to print paper HCFAs directly from maketags, contact PCC Support. PCC support can make configuration changes that enable direct printing, but there may be a better solution to your problem. When you print claims directly from maketags, the claims are not processed according to the electronic submission configuration rules and claim errors may result.
When your practice has direct paper printing enabled, the maketags program will show you an additional option once charges have been collected:
Select “Print the Forms Now” and press F1 – Generate Report. You will see the same HCFA printing interface as found in the [prog]hcfa[/prog] program. You can select one batch at a time, and you will have the opportunity to print (and test print, if necessary) all of the claims you just batched without leaving maketags.
Special Printing Use Only: Only the claims that you processed in maketags are available on this screen. The batches will not include the current claims located in your normal claim batches. Remember, claims printed directly from maketags may not receive their insurance specific configuration rules. For best results, use maketags to batch all claims and process or print them later using Practice Management’s claim submission tools (see Submit Claims).