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Insurance Report - Outstanding Claims by DOS Month

The Outstanding Claims by Date of Service Month report lists insurance claims with an Outstanding claim status by the Date of Service, sorted by month.

This report was introduced in MacPractice Build 10.7.6.

This documentation contains the following sections:

Filters and Options

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The Filters in this report are similar to many other Insurance reports. Once you've selected and configured your desired filters and options, clicking the Apply button will generate your report results.

  • Filter Providers: The Providers filter narrows down the presented results based on the provider listed on the Insurance Claim.
  • Filter Offices: The Offices filter narrows down the presented results based on the Office listed on the Insurance Claim.
  • Filter Insurances: The Insurances filter narrows down the presented results based on the Insurance Company connected to the Insurance Claim.

The other options include:

  • First Date of Service Start Date/End Date: These fields allow you to narrow the results down by the first Date of Service that appears on the claim in question.
  • Claims to Include: This pop up menu allows you to select what type of claims you'd like to include in the results. You can choose Paper, Electronic, or Both types of claims.
  • Plan Type: This pop up menu allows you to select what Insurance Plan Types to include in the results. This is set to "All Types" by default.
  • Threshold Claim Type: This pop up menu allows you to narrow results based on the threshold of timeliness of the claim.  Options include Warning Claims, Past Timely Filing Limit, an option for both, and All Types.

Results

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Once you click the Apply button, the Results will generate in the lower part of the Reports window. Remember that you can press Command-P to print this and any other report once results are generated.

Results are divided up by the Date of Service Month. You can expand the results multiple times to get more detailed information on each expanded level. Keep reading to review what columns of data are available in each level of expansion, and the meaning of each column.

Unexpanded Columns
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  • Month/Year: Indicates the DOS Month/Year in which claim data exists.
  • Open Claims: How many Open Claims exist in this month/year.
  • Total Fee Amount: The Total Fee Amount of all outstanding claims within this month/year.
  • Total Open Amount: The Total Open Balance Amount of all outstanding claims within this month/year.

First Expansion Columns (Insurance Company Level)

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  • Insurance Company: Indicates the Insurance Company which claims are for.
  • Phone #: The Phone Number of this Insurance Company.
  • Open Claims: Indicates the Open Claims for this insurance company for the currently expanded Month/Year.
  • Total Fee Amount: Indicates the Total Fee Amount for the outstanding claims for this Insurance Company's expanded Month/Year.
  • Total Open Amount: Indicates the Total Open Balance Amount for the outstanding claims for this Insurance Company's expanded Month/Year.
  • Timely Filing Limit: The Timely Filing Limit for this Insurance Company.

Second Expansion Columns (Plan Level)

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  • Plan Name: Indicates the Plan Name which claims are for.
  • Phone #: The phone # associated with this plan.
  • Open Claims: Indicates the Open Claims for this Plan for the currently expanded Ins. Company and Month/Year.
  • Total Fee Amount: Indicates the Total Fee Amount for the outstanding claims on this Plan for the currently expanded Month/Year.
  • Total Open Amount: Indicates the Total Open Balance Amount for the outstanding claims on this Plan for the currently expanded Month/Year.

Third Expansion Columns (Claim Level)

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  • Patient #: This Patient's ID number in MacPractice.
  • Patient Last, First: This Patient's Last and First Name.
  • Claim Charges: The Charge Fee Amount on this claim for this patient under this plan.
  • Ins Paid: How much insurance has paid on this claim for this patient under this plan.
  • Pat. Paid: How much the patient has paid on this claim for this patient under this plan.
  • Write-Offs: How much have been contractually written off on this claim for this patient under this plan.
  • Balance: The current open balance for all claims for this patient under this plan.
  • Days Open: How long this claim has been open and outstanding.
  • Posted: The Date the Claim was posted in MacPractice.
  • Type: The Type of Claim that was posted. (eClaim or Paper)
  • First Proc Date: The first procedure date listed on this insurance claim.
  • Birthday: The Patient's birthday.
  • Subscriber: The Patient's Subscriber ID as listed in Patients Ability > Primary/Secondary > Insurance.
  • Pr/Of: Stands for Provider/Office. This indicates the responsible provider ID and office ID, as defined in the Provider's User Reference and Office Reference in the References Ability.
  • Days to Timely File: How many days remain to file the claim before the Timely Filing Limit.   This will also determine if this row is outlined in red or pink. (Red indicates past Timely Filing, pink indicates that Timely Filing is close.
  • Comments: How many comments are tied to this claim.

Fourth Expansion Columns (Charge Level)

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  • Procedure Date: Indicates the procedure date of this charge on the claim.
  • Procedure Code: Indicates the procedure code used for this charge on the claim. This can include a "Comment" code.
  • Procedure Description: Indicates the description of the procedure code used for this charge on the claim. This can contain a comment if the Procedure Code column contains a comment.
  • Procedure Fee: The fee of the individual charge in question.
  • Allowed: The allowed amount currently set on the charge in question.
  • Pat. Portion: The remaining patient portion on the charge in question.
  • Ins. Portion: The remaining insurance portion on the charge in question.
  • Pat. Paid: How much the patient has paid on the charge in question.
  • Ins. Paid: How much insurance has paid on the charge in question.
  • Write-Off: The contractual write off applied to the charge in question.
  • Balance: The remaining overall balance on the charge in question.

 

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