Submit Claims

Open Claims

Open the Claims tool from the Tools menu in PCC EHR.

One Authorized User at a Time: The Claims tool can only be opened by authorized users, and only one user at your practice can open the tool at a time.

Click “Prepare Claims”

Click “Prepare Claims” to begin preparing your claims.

Your PCC system will review all charges that are ready to be turned into a claim.

What Makes a Charge Ready to Be Turned Into a Claim?: Encounter charges are ready to be turned into a claim as soon as you post them into PCC’s system. You also make charges ready when you select “Generate a Claim” from the Correct Mistakes (oops) screen, which you would do (for example) after you change the responsible party for charges.

Claim Scrubbing and Preparation: As your PCC system reviews charges and prepares outgoing claims, it removes duplicates; verifies patient, charge, and payer information; and checks over other details, such as whether CPT codes are valid for a given date of service. Next, it determines which payer or clearinghouse-specific configuration will be used to format the claim.

Review Claim Processing Results

When it finishes preparing, the Claims tool displays three sections that show you how many claims will not be submitted, are ready to submit, and will be routed to paper.

Use the reference below to learn more about each of these totals.

• Will not be submitted:

  • Delayed: Claims delayed due to your practice’s claim delay setting, usually a few days. PCC Support can customize your claim delay period for you.

  • Held: Claims that were identified and prepared, but then held due to a Claim Hold.

  • Need Corrections: Claims that were prepared and found to contain one or more problems that prevent the claim from being submitted. These claims will not leave your system until you correct the problems.

• Electronic claim batches prepared to submit:

  • Claims that were prepared and are now ready to be submitted electronically. Claims are grouped into batches, and by default “All Claims” will be selected. (See the next step for more information.)

• Claims to be routed to paper:

  • Claims that were prepared and will be moved over to a paper holding batch when you click “Submit Claims”. These claims can later be printed from the Partner hcfa program.

Optional: Select Specific “Batches” to Submit

If your practice divides up billing responsibility by payer, or you have another less common workflow need, you might wish to submit only a portion of the prepared claims.

Click Edit, and then select which batches you wish to submit.

What is a Batch?: A batch represents an under-the-hood custom claim configuration on your PCC system. All the claims in a batch use the same claim configuration, so a batch might be named for a large group of payers. If your practice has an unusual claim configuration need, PCC’s EDI configuration specialists sometimes create a custom batch. Your list of batches may also reflect claim clearinghouses or other entities.

Click “Submit Claims” and Confirm

When you are ready to send the prepared claims, click “Submit Claims”. Then click “Submit Claims” again to verify and proceed.

Submitting claims can take several minutes, especially when you have a large number of claims, as PCC re-verifies claim information.

Review Results

When claim submission is finished, you can review how many claims were submitted and routed to paper.

Click “Close” to close the window.

Additional Prepared Claims: If you prepared claims and then only selected and submitted certain claim batches, you can now select additional batches and submit them.

Print Paper Claims

If some claims need to be printed, they will be “routed to paper”. Use the hcfa program in your Practice Management windows to print paper claims.

Follow Up on Claims that Need Corrections

If a claim can not be submitted, you can find an explanation of the problem on the Need Corrections tab. See the sections below to learn more.

You can also find these claims in the “Bad Claim Report” in the EDI Reports (ecsreports) tool. Or, you can use the SRS “Claim Error Report” to track down both claims that could not be submitted and claim rejections.

These claim errors (that “Need Corrections”) must be resolved before the claim can go out. For example, you may need to update patient, account, or charge information. As no claim has gone out yet, you do not need to file a “Corrected Claim” or include a payer claim control number. You can fix the problems and then return to the Claims tool to prepare and submit claims again.

Optional: Review Log

When you are finished submitting claims, you can use the Log tab to review the record of what occurred during claim processing.

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 F6 – Patient Editor, enter the patient’s birth date, and then press F1 to save and continue.

Press F3 – Ignore 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 F3 – Select All and then press F1 – Process 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.