Work on Claim Errors, Rejections, and All Unpaid Claims

After you prepare and submit claims, how do you deal with stuck claims, rejections, claims with no response from the payor, and other unpaid encounters?

Read below for an overview of PCC’s tools for your insurance A/R workflow.

Contents

1 Fix Claims that Need Corrections
2 Respond to Every Claim Rejection
3 Read Electronic Remittance Advice From Payors
4 Review the Claim History of a Specific Encounter
5 Followup on Unpaid Encounters with Insurance Balances

Fix Claims that Need Corrections

Your PCC system automatically catches many problems before a claim leaves your practice; it holds back claims that contain errors or otherwise need corrections.

After you prepare and submit claims, you can review all claims that need corrections.

You can work your way down the list, open each queued claim for more information, and use tools in the Claims tool to correct the issue. The claim will then go out when you next prepare and submit claims. Claims that needed corrections are also logged in the Log tab of the Claims tool.

For more information, read Submit Claims.

Respond to Every Claim Rejection

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.

To learn more, read Respond to Claim Rejections.

Read Electronic Remittance Advice From Payors

You can review all ERAs from payors in the Electronic Remittance Advice tool.

ERAs provide complete details about the payor’s adjudication, including payments, adjustments, denials, and unusual circumstances. Read the Read ERA 835s from Payors article to learn more.

Review the Claim History of a Specific Encounter

When you need to understand when a claim was sent, acknowledged, rejected, paid, or resubmitted, use the Claim History found in the encounter’s Billing History.

The Claim History shows the lifecycle of all claims for the encounter, from submission to resolution. You can see when a claim was queued, held, delayed, processed, received by PCC’s clearinghouse, acknowledged by the payor, and more. By clicking on a link, you can read the payor’s original electronic response.

For more information, read Review an Encounter’s Billing History.

Followup on Unpaid Encounters with Insurance Balances

What if a problem was fixed, but a claim was never resubmitted? And how can you follow up on appeals, or on claims where the payor never responds? Use the Unpaid Encounters tab in the Insurance Balances tool to review an aged summary of your insurance A/R and an unpaid encounters worklist.

To learn more, read Follow Up on Unpaid Encounters with Insurance Balances.

Here are some related articles in Billing and Practice Management > Bill Insurance:

Read ERA 835s from Payors
Use the Electronic Remittance Advice tool in PCC EHR to read any ERA on your system and review the adjudication for a claim.
Read EDI Responses to Claim Submissions
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.
Submit Claims
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.
Insurance Billing Overview
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.
Review Archived EDI Reports
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.
Print Paper HCFA Claim Forms
While most claims are transmitted to payors electronically, sometimes you may need to generate paper 1500 HCFA forms, or print a single paper claim.
The Claim Journey Explained
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.
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.
Add an Attachment Code to a Claim
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.
Configure Capitation and Capitated Plans
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.
Edit the Insurance Plans on Your PCC System
Use the Tables tool in PCC EHR to add a new insurance plan and configure the payors you send claims to.
Submit Claims
Prepare and submit claims. Then work on any claims that were stuck and couldn't be submitted.
Configure Claim Holds and Claim Delay
Watch this video to learn how to hold claims for specific providers, locations, or plans and how to configure your practice's claim delay.
Configure Claim Holds and Claim Delay
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.
Claim Processing and Needs Correction Error Reference
What kinds of pre-submission processing does your PCC system do on claims? What errors can it find, and how do you fix them?
Track Newborn Charges and Delay Billing the Family
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.
Respond to Claim Rejections
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.
Respond to Claim Rejections
If unaddressed, rejected claims result in lost revenue. Use the Rejected Claims worklist in the Insurance Balances tool to review and respond to every claim rejection sent to your practice.

Fix Claims that Need Corrections

Respond to Every Claim Rejection

Read Electronic Remittance Advice From Payors

Review the Claim History of a Specific Encounter

Followup on Unpaid Encounters with Insurance Balances

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