Billing: Reconciling claims list
Last updated: 2008-10-07 10:53:02 by cara
This document has been accessed 438 times since 2006-12-28 14:21:58
After receiving payments back from Alberta Health Care
Check unpaid claims:
- From menu bar:
- Accounts; Claims List
- At bottom of page, click on Show All; Outstanding.
- This will bring up all your outstanding claims.
- To organize your claims by batch(or any fields at the top) single click on batch for ascending, double click for descending order.
- Also watch for agency`s ABH, WCB, PT and there are others
- If the balance is black and in brackets this means it was an over payment. Double clicking on this claim and hitting the zero button will zero the balance and remove it from your outstanding list.(After hitting the zero or paid button in a claim it moves you directly to the next claim so do not keep hitting the buttons).
- If the outstanding balance is green the claim is very new(probably in your current batch).
- If the outstanding balance is blue then the claims are a little older.
- If the outstanding balance is orange then the claims are about 3 or 4 months old and should be looked at before they are too old to submit.
- If the outstanding balance is red the claim is very old, very close to 6 months(claims will no longer be paid if they are more than 6 months old).
Fixing an unpaid claim.
- Double click on the claim line to open up the claim.
- If your claim has not been paid check the lower left side of billing screen for details on why claim was not paid.
- The first an most important thing to look for when fixing an unpaid claim is the assessment outcome (which is in the very bottom right corner) If it is an H it is on hold - dont do any thing with it. If it is an A it has been assessed and needs to be changed - use your action code. If it is a R it has been refused- resubmit with a new claim number
- Make necessary changes to the claim. If the claim has been refused then resubmit claim with new claim number.
- If the claim is on hold DO NOT submit with new claim number, make changes and change the action code to `C`(change) or add and explanation in the comments box and change the action code to `R`(reassess)
- If the claim needs to be deleted (example paid to wrong Dr. or wrong patient) then change the action code to a `D` (delete). When the claim comes back with the money taken back then you can bill under the correct person/Dr.
- By re-submitting with new claim number or changing action code, automatically place your claim into the next batch for resubmission to Alberta Health.
- A-Add transaction: Used when adding a new claim number. The claim number cannot have previously been sent.
- C-Change Accepted Claim: Used when changing an existing claim that has previously been accepted by Alberta Health. A claim is considered accepted if already assessed and applied. If the pervious claim transaction for this claim number had been refused by Alberta Health, then a change cannot be accepted.If claim is on hold it is considered accepted.
If your claim has been checked as paid $0:00 amount you must change the action code to C. If you were to just resubmit this type of a claim with a new claim number Alberta Health would rejected the claim stating this was a duplicate claimed item.
- R-Reassess with text: Used to cause a previously assessed claim to be re-assessed with text taken into consideration. Normally, excepted for specific situations (e.g. claim for unlisted procedure), text is ignored when a claim is initially assessed and results in payment.
- D-Delete Accepted claim: Used to delete an existing claim that has previously been accepted by Alberta Health. No segment data is required. In the event if a Change, Reassess, or Delete transaction is refused, the initial applied claim that was to be changed/reassessed/ deleted is left as is.