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eClaims Usage Guide - eClaims Node

Overview
This guide will give a rundown of day to day use of the eClaims Ability and the elements within, with explanations of item functions and details of how to each element within the eClaims Node is to be utilized. Other information regarding the eClaims Ability can be found here.

eClaims Node
This node does not twist down further into sub-items in the sidebar. Selecting the eClaims Node in the Sidebar will bring up the main eClaims window to the right. The main eClaims window contains all of the elements necessary to interact directly with eClaims that have been created, whether created in a patient's ledger or in the New Claims Manager.

When the eClaims Node is selected, the main eClaims window is composed of three main sections: the eClaims Table, the Claim Details Panel, and the eClaim Status Panel. Each section has a specific purpose related to management of electronic claims.


Bins
When the eClaims sidebar item is selected, the tabs at the top of the eClaims main window are labeled from left to right: Invalid, Ready, Sent, Rejected, Accepted, Paid/Closed, and Archived. These tabs are often referred to as 'bins' and are used to sort eClaims by their various statuses.

If an office subscribes to the MacPractice partner clearinghouse, Change Healthcare, eClaims will move automatically to the appropriate bin based off of automatic clearinghouse and payer reports. Claims will also move based off of the user’s activity.

If an office does not subscribe to Change Healthcare for their electronic claims, automatic clearinghouse and payer reports will not be transmitted back to MacPractice. As a result, claims will not automatically move. Under these circumstances, bins are utilized entirely based off of user input.

There are filters by which a user can view claims. The filters that affect which claims are viewable are Template Filter and the One/Many Selection.

When no filters are set, each bin will show a single number. That number indicates the total number of claims that are present within that bin.

When a filter is set, only claims that fit the filter requirements will be visible in any of the bins. The number in the bin tab will be split into two numbers, divided by a slash. The number to the left of the slash indicates the number of claims present in the bin that are viewable, based on the filters that are set. The number to the right of the slash indicates the total number of claims within that bin.

If ever there is an asterisk (*) beside the number in the bin tab, this indicates that the software is calculating the number of claims within the bin. The asterisk should disappear once MacPractice has counted all of the claims in all of the bins.


eClaim Bins and Claims Management
The purpose of the bins in the eClaims Ability to provide MacPractice users with the tools to exercise good claims management.

Good claims management is essential to an office's revenue stream. It is important for all claims to be reviewed regularly. We recommend reviewing claims daily or, at the very least, weekly. This will ensure that rejected claims are addressed quickly. It will also help to ensure that any accepted claims that haven't received an EOB response in a timely manner are taken care of, so that the office can receive payment as soon as possible.

Note that MacPractice does not track claims for any office and MacPractice does not directly contact offices to notify of any rejections, denials, or any other claim status. Claim statuses are sent back to the office by way of the clearinghouse. These statuses are the indicators that an office's billing department needs to track, in order to determine if any claims need to be corrected and resubmitted.


One/Many Button

The One/Many Button is located in the top, left corner of the eClaims Ability. If the MacPractice program's focus is not on a specific patient, the One/Many panel will read as "No Patient Selected" and it will have an icon of three, different colored, peg figure people. When the One/Many Button appears this way, claims for all patients will be viewable in the current bin. This indicates that the software is in Many Mode.


In order to put the focus on a single patient from within the eClaims Ability, the user will need to select an eClaim that is for the desired patient. Once that is selected, click on the icon of the three, peg figure people. This will set the software to One Mode.


Once in One Mode, only claims for the selected patient will be viewable. When the user goes anywhere else within MacPractice that operates in One/Many Mode, such as the Patients Ability, only records for the selected patient will be viewable.


Other Terms Mentioned in this Article
The .CLM File
The .CLM file is often referred to as the claim file or the batch file. The .CLM file is generated at the time a user clicks the Send Button. This is the file that is transmitted to the partner clearinghouse, Change Healthcare, when claims are sent. For non-partner clearinghouses, this is the file that gets manually uploaded to the clearinghouse.

.CLM files contain all claims that were generated at the time the Send Button was clicked. If multiple claims were sent, they are most likely all contained on a single .CLM file. There are situations in which some claims are written to one .CLM file, while other claims are written to a separate .CLM file. If an office manually uploads their claims, it is important that the users exercise vigilance and upload all of the files that are generated at the time of clicking the Send Button.

The file path to find the .CLM file is only accessible when a user is logged into MacPractice. .CLM files are stored locally and are only accessible from the computer on which the file was generated.

To find .CLM files generated on a computer, open a Finder Window. While in Finder, in the menu, select "Go". In the menu select "Go to Folder...". When the sheet drops down stating "Go to the folder: ", type in the following and click "Go": ~/Library/Application Support/MacPracticeClient/Databases/macpractice/Claim Templates.

The files will be titled with the following format: 2016070516441234_123. The first eight digits of the file name indicate the year and date, in reverse order, of the day the file was created. The next four digits indicate the time, in military time, that the file was created.

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    Joshua Herr MS, L.Ac

    I'm really glad Podrick has health insurance. Could come in handy with the white walkers.