PCC's insurance billing tools help you submit claims in just a few minutes. You can review claim problems quickly and easily, make corrections and resubmit claims, and then review rejections using clear, straightforward tools.
Read the Submit Claims procedure below to learn how to send out claims. Then read further to learn more about how to work down your insurance accounts receivable.
- Follow this procedure to prepare and send claims.
- Partner's insurance billing tools help submit claims, review rejections, and work down your insurance accounts receivable. Partner helps you maximize the use of your time as you pursue proper insurance reimbursement.
- When insurance carriers send payment and adjustment information, either on an EOB or an ERA, they often include a code with a small message. These codes are known as CARC values, or Claim Adjustment Reason Codes, and they are an industry-wide standard.
- Every insurance claim in Partner has a unique identification number. The number appears in various Partner reports and programs, and you can use it to improve claim tracking and payment posting.
- You can review and confirm patient insurance eligibility in either PCC EHR or in the Partner practice management system. This article teaches you how to use Partner's eligibility program to review status for upcoming appointments.
- Hopefully most of your claims are submitted electronically. Some claims must still be printed on paper, however. The procedure above provides the basics. This section describes additional details and options in the
- 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.
- PCC automatically checks insurance eligibility for all of a scheduled patient's active insurance plans, if the carriers support automated eligibility. You can use eligibility features in PCC to review and confirm eligibility for upcoming appointments. You can also review and re-check a patient's insurance eligibility status during Patient Check-In.
- Edit and Resubmit Claims
maketagscan find and rebatch charges by a wide range of criteria, including age, balance and insurance status, insurance plan, and provider. Read below to learn more about the different criteria you can select from the first screen in
- You can rebatch and print any single claim, for any charge or visit, from the Correct Mistakes (
oops) program. Sometimes, however, you need to resubmit all of the claims for a certain insurance group, a specific date range, or all of the claims containing a certain procedure. Resubmit HCFA Forms (
maketags) is a program that finds and re-batches large groups of unpaid or paid claims.
- Follow the procedure below to resubmit a single insurance claim.
- Under unusual circumstances, you may need to force a batch of claims to print without processing them.
- You can run
maketagsand resubmit large batches of charges quickly and easily. Follow the procedure below and read the other sections to learn more.
- Have you ever needed to resubmit all claims with a certain procedure, place of service, or for accounts with a specific status flag? Use
maketags's Smart Report Suite (
srs) features to create custom restrictions specifying which charges you would like to rebatch.
- 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 can add attachment codes to a visit’s charges, generate a unique attachment ID, and specify the attachment type and method.
- Review EDI Reports
- An ERA is an electronic version of the traditional EOB. Instead of receiving a printed, paper explanation of payments and adjustments, an ERA arrives electronically and payment is sent separately or deposited directly into your practice's bank account. ERAs appear along with other reports on the main EDI Reports (
- This glossary includes definitions and examples of several important EDI Reports. As always, feel free to contact PCC Support at 1-800-722-1082 if you have any questions or need help understanding EDI reports.
- PCC, claim clearinghouses, and carriers all send EDI reports. How do you know which reports are important to review, and which reports are merely for reference purposes?
- Your office receives many different electronic reports related to claims or other electronic submissions. These include:
- The ERA Reports program (erareports) lists remittance advice that insurance carriers sent to your office. As soon as Partner receives an electronic EOB from a carrier, it reads the file and creates "check" files, which can be viewed on the main screen in erareports.
- The EDI Reports (
ecsreports) program stores and displays claim and transmission related messages and reports. You can quickly search, review, and print the reports, as well as track which reports you have printed in the past.
- Training Video
- Track and Work on Outstanding Claims
insagingreport shows you an aged summary of your practice's outstanding charges broken down by insurance group. It is a helpful collection tool that can show you which carriers owe you the most money and how old those balances are. The
insagingreport is also a quick way to see your total A/R, and it will help you determine which insurance carriers need follow-up attention.
inscoarreport provides a detailed charge-by-charge accounts receivable for your insurance companies. You can use
inscoarto find insurance charges that have not been paid and to work down old, overdue charges. In addition, interactive
inscoaris a great work environment from which you can research billing history, make changes, and resubmit claims.
- In addition to reading the inscoar report and using it to call insurance companies, you can perform a wide range of functions while viewing
inscoar. You can research account history, correct and resubmit problem claims, and add notes to the patient or account. These features and more are available through the Interactive Screen
- Insurance claims are not always paid, and insurance carriers do not always send you an explanation. Therefore, you need tools to track and work-down your outstanding claims. The topics below explain Partner's tools for claim work.