Submit Claims

Follow one of the procedures below to prepare and send claims to insurance companies and other payers.

Submit Claims in PCC EHR, or in Partner?: After the January 2023 release of PCC 9.5, your practice can submit claims from PCC EHR or from your Practice Management windows. Switching back and forth between the tools can result in incomplete logs and other problems. For best results, choose one tool. For more information, read the PCC 9.5 Migration Considerations article.

Watch a Video: Watch a video to learn how to submit claims in PCC EHR.

Submit Claims in PCC EHR

When you are ready to process claims and submit them to payers, use the Claims tool in PCC EHR.

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 and Close

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.

Optional: Review Log

When you are finished submitting claims, you can close the Claims window, reopen it, and use the Log tab to review the record of what occurred during claim processing.

Where's My Log?: You must close the Claims tool and reopen it before a log will appear on the Log tab. Read below for more information.

Follow-Up on Paper Claims

If some claims needed 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 Log 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 (or “Needed Corrections” claims) must be resolved before the claim can go out. You may need to update patient, account, or charge information. If the encounter is pending the wrong insurance company, or there is another policy issue, you may need to use the Correct Mistakes (oops) program to change the responsible party for the charges and then generate a new claim.

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 the remaining claims.

Working on “Needed Corrections” Claims

Each time you submit claims, PCC will evaluate all claims that are ready to be submitted. For example, if a claim is missing a family’s home address, you can edit the account demographics and then submit claims again. PCC will review the same set of charges, and then process and submit the claim.

However, if a claim is pending an insurance company that is not active for the date of service for the charges, then the previous claim will be discarded. After you update the patient’s policies, and (if necessary) change the responsible party for the charges (F4Insurance Status in oops), you must use F2Generate Claim in oops to create a new claim.

PCC is developing additional claim submission followup tools in an upcoming release, including a tool for deleting old claims after you make corrections. Reach out to PCC Support to discuss your claim workflow and which tools will work best for your practice.

Review Claim Submission Session Logs

When you use PCC EHR to submit claims, you can use the “Log” tab in the Claims tool to review the details of a claim submission. You can also review which claims were held, delayed, needed corrections, or were routed to paper.

The Log tab displays a record of all claim submissions run from PCC EHR, filtered by year. In addition to date and time, you can see which user at your practice processed the claims and how many claims were held, delayed, needed corrections, were routed to paper, and were submitted. If only some batches were submitted, you can see how many under the Batches column.

Where's My Log?: In PCC 9.5, you must close the Claims tool and reopen it before a log will appear on the Log tab. The Log tab defaults to display sessions from 2022, so you may need to click on the year menu to review logs for 2023. PCC plans to address these issues in an upcoming software release. Also, a claim submission session log is only recorded when claims are submitted. If you prepare claims but do not submit any batches, the Claims tool will not add a submission record to the Log tab.

Double-click on a session log to see more information.

On the “Claims – Submission Session Log – View” screen, you can review details about each claim that was processed during the claim submission. If the user prepared and submitted multiple batches during the same session, they can use the drop-down menu in the upper-left to select and review each submission.

Use the Search Filter to find claims by name, date of service, insurance plan, batch, or claim ID.

Review Held Claims

To see details about all claims held due to a claim hold, select “Held” in the session drop-down menu.

Your practice can configure custom claim holds based on dates of service, billing providers, and insurance plans.

Review Delayed Claims

If your practice uses a customizable claim delay, select “Delayed” from the session drop-down menu to see claims that were delayed.

You can review the details of claims that didn’t go out because the claim delay period had not yet passed. The claim delay period is displayed in the upper-right corner. Typically, practices ask PCC Support to configure a claim delay period of a few days, in order to ensure enough time has passed for charges to be reviewed before claim submission.

Review Claims that Need Corrections and Can Not Be Submitted

If PCC’s claim processing found problems with claims that prevented them from being submitted, you can review these issues by selecting the Needed Corrections option.

You can see claim details and the “Reason” that a claim could not be submitted. You can find this same information in the “Bad Claim Report” in the EDI Reports (ecsreports) tool.

These issues must be resolved before the claim can go out. For most problems with an outgoing claim, you will need to update patient, account, or charge information. If this alters the responsible party for the encounter, you will need to edit the insurance information for the charges and regenerate the claim in the Correct Mistakes (oops) program.

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 the remaining claims. If a claim pended the wrong insurance plan, you will need to generate a new claim (see above).

Review Claims Routed to Paper

If some claims needed to be routed to a paper batch for printing, you can select “Routed to Paper” to review details.

To generate and print paper claims, use the HCFA Form Generation program in your Practice Management windows.

Submit Claims in the Partner Practice Management Windows

Follow the procedure below to prepare and send claims using the workflow found in your Practice Management windows.

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.

  • Last modified: January 12, 2023