Edit the Insurance Plans on Your PCC System

Use the Tables tool in the Configuration menu in PCC EHR to update the list of plans that your practice bills.

Your practices receives many different electronic responses to claim submissions and billing. Read this article to learn the different EDI responses, which responses require attention, and how to use PCC's tools to review and respond.

Use the Claims tool to process and submit claims to insurance companies and other payers, work on claims that could not be submitted, and review a log of submissions.

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.

After you submit claims, your practice will receive clearinghouse and payor acknowledgements as well as ERAs and other electronic notifications from PCC, claim clearinghouses, and payors. You can use tools in PCC EHR to review these responses. When you need to do deeper research, you can use the EDI Reports (ecsreports) program.

While most claims are transmitted to payors electronically, sometimes you may need to generate paper 1500 HCFA forms, or print a single paper claim.

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 carrier requires the same clinician information for each claim: a name, a taxonomy code, a National Provider Identifier, and a Tax Identification number. Follow the procedure below to enter or update this information in Partner.

Tables are lists in your PCC system. For example, your practice's system has a list of insurance policies, clinicians, visit reasons, billing procedures, and more. Use the Tables tool in PCC EHR when you need to add a new billing code, a new insurance plan, a new payment type, or other new item to a table. You can use the Tables tool to make configuration changes that improve the accuracy of your reporting.

Read this article to learn how to set up a new clinician in PCC EHR.

You can use PCC to track your payor contract fee schedule amounts, also known as "allowables" or the "allowed amount" for each procedure. Then, when autoposting insurance payments, you can review any responses on the ERA that did not match the fee schedule. When you manually post insurance payments, you can see whether or not the payment amount you enter matches the fee schedule. Later, you can report on whether or not payors are honoring their contracts.

Use the Billing Configuration tool to configure billing behaviors of procedures and diagnoses and the Billing screen in PCC EHR. Follow the procedures below to open the Billing Configuration tool and make changes.

If a secondary insurance requires the EOB from the primary, or any claim requires a certificate of medical necessity, discharge summary, or other clinical documentation, you need to send an attachment to the payor. You can edit the encounter and add an attachment code to an encounter, generate a unique attachment ID, and specify the attachment type and method. Attachment information will then be sent with the electronic claim.

Capitation payments are not like other income. How should you configure PCC EHR in order to track payments you receive as part of your participation with a capitation insurance plan? PCC Support will complete the steps in this article for you, but you may find the instructions helpful if you are a system administrator or practice manager and make updates to your PCC tables.

When you need to add a new billing code to your PCC system, create a new version of a code that includes modifiers, or adjust your practice’s prices for procedures or adjustment types, use the Tables tool in the Configuration menu.

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 also configure your practice’s claim delay, which prevents any claim from going out until a certain number of days after the date of service.

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?

If you bill for newborn encounters before the family has updated their insurance, will your PCC system send them a large bill? Your practice can add a newborn patient to your PCC system, track newborn hospital and office encounters, and delay billing until the family has updated their insurance information. Read below to learn more.

If unaddressed, rejected claims result in lost revenue. Use the Rejected Claims worklist to review and respond to every claim rejection sent to your practice.

Custom status flags grant your practice special powers for handling unique needs.