Oct 24, 2016
The Claims Manager is located in the Manager’s ability. This class will focus on the New Claims and Outstanding Claims Managers.
New Claims Manager is an excellent tool to use in MacPractice as a safety net to create any claims that you may have forgotten to create. New Claims Manager will search through the system and create claims based on the following criteria: if the patient has insurance, has open charges, and has not yet had a claim created for those charges; those claims will be created here.
First, you’ll see the filters located at the top of the window. We can filter the manager by Provider, Office and Insurance Company. If you need to look for claims for a specific insurance company this is where you can make that selection. More importantly, there are Start and End date fields in order to narrow down the range of charges it will pull.
Once you are finished entering your filters, you’ll need to click the “Apply” button to generate the report.
You’ll notice that there are some checkboxes you can use to see specific types of claims. If you only want to see primary claims, you can turn off the Secondary Claims checkbox and vise versa. There are also checkboxes to show only paper or electronic claims.
Once you’ve got the list of claims you’d like to create, simply verify there is a checkmark in front of the claim and click the Create Claims button to generate the claims. If they are paper claims they will be printed, if they’re eClaims they’ll be sent created for you and waiting in the eClaims ability to be sent out.
You’ll also notice that Claims Manager will give you an unpaid column. You can click on the claim and view the charges associated to it in the box below. The procedure and diagnosis codes as well as the fee total and the unpaid amount will be shown. So at a glance you can see if there’s been a payment associated to the charge.
One thing you might need to look for when using New Claims Manager are claims with $0 unpaid balances. The detail will show below, but there might be instances where the patient has paid the entire balance and the manager is still trying to submit it to insurance because it’s possible that the insurance carrier will cover what’s already been paid.
If you need to take a closer look at the account, select the patient name, then click the “Go To Patient” button.
In this example, I can see that this was a balance transfer charge and the patient paid cash for it. I don’t want this charge to go to insurance, it probably should have been marked Patient Responsible but it wasn’t and that’s why it’s pulling in New Claims manager. I can remove it by clicking the remove procedure checkbox then the Update Claim button and this charge will never pull into New Claims manager again.
This is a perfect example of a charge that has $0 unpaid but I do want to submit it to insurance because they might still pay on it even though the patient has made payment.
If the patient has a prior authorization you can see it in this column here.
You can also see the form or template. If you need to change the template or form for the claim you can select that claim and then use the Change Form/Template drop down to do so. Use this if you need to drop an eClaim to paper, or vise-versa.
We have the Accept Assignment checkbox so if you need to mark these as accepts assignment you can do so easily. There is a Check All box that allows you to mark accepts assignment really quickly for all insurance companies here. We have the same type of Check/Uncheck All option for creating the claims as well.
At the bottom you’ll notice a tally of all the claims that are in the window to be generated as well as an entry field for the Batch Name. By Default, this will be today’s date and time but you can use whatever name will help you keep them organized best.
Once I have made my selections and edits, I will press the “Create Claims” button.
Next we have the Outstanding Claims Manager. As the name suggests, it is a great way to manage all outstanding claims. This is designed to search for all claims in all patient accounts that are set to any status other than Paid/Closed. This will allow you to investigate why the claim is still outstanding and re-create the claim if necessary in an attempt to obtain payment from insurance.
The filters are the same as the New Claims manager. But it’s more important to set a date range with this manager because the potential for large amounts of data is greater which can cause the report to take longer to generate.
You can use this manager to reprint your paper claims if needs be. It’s really helpful when you need to reprint multiple claims at once.
The remaining claims managers are not used very often, but I will take a moment to briefly introduce them nonetheless.
There is a View in Ledger button that will take you directly to that claim in the ledger for further inspection.
The Paid/Closed Claims Manager works exactly the same way as the Outstanding Claims manager, except the claims pulled will be only those set to Paid/Closed. It’s really important to use a start and end date with this report as well.
There is a Batch Claims Manager that you can use to see all claims that have been created for a particular day or date range and you can see which user created these particular claims. These are the batches created using the New Claims manager. So we can see the Batch Name we used when creating a batch of claims earlier. If you need to reprint these claims you can do so. This will not create a new claim in the ledger since there is already an existing claim.
The Insurance Appeal feature in your Claim manager is used to contest an insurance payment when the insurance company fails to meet the allowed amount that has been agreed upon between you and the company. It allows you to print detailed information about when a claim was sent, including the insurance payment posted date, posted amount and so on.