This is also documented in the Revenue Manager User's Guide!
- Create
claims in the claim manager
- Activities->Claim
Management
- Click the 'Create Claims'
button
- Normally when you
are creating claims you will want to leave the filters blank to capture
all new transactions that have not been already tied to a claim. You will also want to make sure you
have the correct claims assignment selected; Assigned will use the case
provider for Box31 and Attending will use the transaction provider for
Box31 on a HCFA paper claim.
- Open
Revenue Management
- Activities->Rev
Man->Rev Man
- Normally RM will
open the practice database and then the claims process on first launch as
well as selecting the primary ready to send claims.
- If not and RM
opens to a blank practice, select Process->Claims
- This will display the claims
process and will pull in the primary ready to send claims from claim
management.
- Click Check
Claims->Receiver Name
- Expand the
receiver to review claim's edit statuses by clicking the '+' symbol
beside the receiver group.
- For claims with
"Error Flags", expand '+' beside errored claim and check the
History tab
Most
of these errors will be in 'plain english' and are normally easily
corrected. If you return to Medisoft
correct the issue with that claim and then run the Check Claims in RM again,
they will pass if all the errors have been corrected.
- Select Print
->edits to print a report which only contains the failed edit claims
with error messages.
The
report can be used after sending out currently correct claims (start
processing on what can be sent now) to review and correct any claims that were
not immediately ready. Then these
claims will remain at 'ready to send' status until claim are processed again
in RM.
- Select
Send->Claims->Receiver Name
- Errors will be
red; print the failed error report (Print->FailedClaimEdits)
- Remove all failed (failed
claims status will change from ready->Alert)
- Press Send
Button
- One of
three things should happen at this point
- Claims will
process and send automatically to the clearinghouse (Relay Health,
Capario, etc.)
- Terminal window will open
to connect to a dial up BBS to send claims
- This process
maybe automated with scripts (Medicare, Medicaid normally will)
- You may have to complete
this process manually
- Click Connect
to connect, normally you will be presented with a user name and
password prompt, these are provided by your clearinghouse
- Check with your
clearinghouse for specifics while inside the system, but when you
reach a point to send the claims files, simply select the 'send file'
button in the terminal at that time
- A web site will
launch and direct you to the clearing house web portal
- Log into
ClearingHouse
- File->Upload
- Browse to
Desktop->Shortcut to RMData->Practice Folder->Outbound (Find
your RMData folder and then under the practice folder within the
RMData folder, there will be an outbound folder, create a shortcut on
your desktop to this location for easier access) This location can be manually set in
the receiver under transaction set.
- Select the file you want
to send (file name is defined in the receiver under transaction set)
- Close
ClearingHouse site
- Click 'Yes' on
"Claims were transmitted successfully
- The RM
Reports window opens automatically after sending claims, review any
reports and then close the RM Reports window.
- Close claim
preview report
- Close claim
preview window
- Close RM
- Close Claim
manager in Medisoft and reopen to refresh claim statuses
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