After you prepare and submit claims, you must deal with claims that could not be submitted or were rejected.
PCC automatically catches many problems before a claim leaves your practice. It holds these claims back, as they contain errors or otherwise need corrections. Next, after a claim is formatted correctly and is submitted to a payor, they may not accept the claim because they can’t identify the subscriber, or for some other reason. Your practice must address claims that couldn’t be submitted and claim rejections in order to get paid.
Read below to learn about tools for working with claims that need corrections or were rejected.
- 1 Review Claims that Need Corrections in the PCC EHR Claims Tool
- 2 Review Claims that Need Corrections and Claim Rejections in the SRS Billing Error Report
- 3 Review Unpaid Balances in the Insurance Company Accounts Receivable Report (inscoar)
Review Claims that Need Corrections in the PCC EHR Claims Tool
After you prepare and submit claims, you can immediately review all claims that need corrections. There are other tools for addressing them later, but you can see the list immediately in the Logs tab:
You can work your way down the list, and open the corresponding patient chart or use the under-the-hood Correct Mistakes (
oops) tool to address the error. The claim can then be re-submitted when you next prepare and submit claims.
Review Claims that Need Corrections in the Bad Claim Report
PCC’s under-the-hood Practice Management system generates a Bad Claim Report, which includes the same information as found in the Logs tab of PCC EHR’s Claims tool.
Some billers prefer to use this report as it is more familiar to them. If you generate claims using the older claims tools, they print a paper copy of the Bad Claim Report automatically. You can also review and print a Bad Claim Report in the EDI Reports tool.
Review Claims that Need Corrections and Claim Rejections in the SRS Billing Error Report
Use the SRS Billing Error Report to review and work on both claims that couldn’t be submitted and claim rejections.
The Billing Error Report uses SRS, a powerful and customizable tool that lets you filter results to exactly what you wish to work on.
By default, the report will display claim processing errors (“Tagsplit” errors), clearinghouse rejections, and payer rejections. It sorts the results by responsible party and then by billing status. You can use the Correct Mistakes (
oops) program to read more about the error, update charge information, and resubmit a claim.
Review Unpaid Balances in the Insurance Company Accounts Receivable Report (inscoar)
The above worklists will ensure you address all claims that had errors or that were rejected. However, what if a problem was fixed, but a claim wasn’t resubmitted? Or if a problem occurred outside of the range of a log or a report? Or if a payer simply doesn’t respond to a claim?
Use the Insurance Company Accounts Receivable (
inscoar) report to review any unpaid, pending charges.