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Revenue Manager Send Primary Claims

This is also documented in the Revenue Manager User's Guide!

    1. Create claims in the claim manager
      1. Activities->Claim Management
      2. Click the 'Create Claims' button
    1. 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.


    1. Open Revenue Management
      1. Activities->Rev Man->Rev Man


    1. 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.
    1. If not and RM opens to a blank practice, select Process->Claims
    2. This will display the claims process and will pull in the primary ready to send claims from claim management.
    1. Click Check Claims->Receiver Name


    1. Expand the receiver to review claim's edit statuses by clicking the '+' symbol beside the receiver group.


    1. 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.


    1. 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.

    1. Select Send->Claims->Receiver Name


    1. Errors will be red; print the failed error report (Print->FailedClaimEdits)
    2. Remove all failed (failed claims status will change from ready->Alert)

    1. Press Send Button


    1. One of three things should happen at this point
      1. Claims will process and send automatically to the clearinghouse (Relay Health, Capario, etc.)
      2. Terminal window will open to connect to a dial up BBS to send claims
        1. This process maybe automated with scripts (Medicare, Medicaid normally will)
        2. You may have to complete this process manually
          1. Click Connect to connect, normally you will be presented with a user name and password prompt, these are provided by your clearinghouse
          2. 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
      1. A web site will launch and direct you to the clearing house web portal
        1. Log into ClearingHouse
        2. File->Upload
          1. 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.
          2. Select the file you want to send (file name is defined in the receiver under transaction set)
        1. Close ClearingHouse site
        2. Click 'Yes' on "Claims were transmitted successfully
    1. The RM Reports window opens automatically after sending claims, review any reports and then close the RM Reports window.
    2. Close claim preview report
    3. Close claim preview window
    4. Close RM
    5. Close Claim manager in Medisoft and reopen to refresh claim statuses