The AWARDS BillingBuilder feature (located in the Fiscal module) enables users to bill payers for services provided to clients and recorded in AWARDS. Payers can include Medicaid, Medicare, managed care, or commercial payers that accept the 837I or 837P electronic billing files, HCFA-1500 or UB-04 paper claim forms, or printed invoices. Self paying clients can also have charges recorded in the BillingBuilder.
In order to bill for services during billing processing, there are two types of data that must be entered in AWARDS:
Client data - Client data required for billing includes the consumer's name, address, date of birth, gender, entitlements/insurance information (authorizations for some payers), and diagnosis information. AWARDS will not generate invoices for clients who are missing any of this information.
Services data - The services data that determines if a client is eligible for billing depends on the billing rules configured in the Configure Billing Types / Procedures components of the BillingBuilder.
Once the necessary client and services data has been entered in AWARDS, the billing process begins with generating a batch of invoices. Invoice batches may then be edited. To submit a batch of invoices to a payer, the batch must first be posted to A/R. Once posted to A/R. the batch can be converted into an acceptable electronic claim file format or paper claim form.
Once a claim file is submitted to a payer and is accepted, the payer will eventually provide remittance information (electronic 835 file to paper/PDF file). When remittance information is received, a remittance worksheet is created to indicate payments, and is then posted to A/R to contribute to a running balance of services billed and remitted. If claims were denied, a re-billing batch may be created and submitted.
This diagram illustrates the main steps in the billing process, each of which will be discussed in more detail in this section of Online Help:
IMPORTANT! Prior to completing the steps of generating invoices and claims, please make sure that you have created fiscal periods in AWARDS. They will enable you to post remittance worksheet information to the relevant fiscal period. To learn more, click here.
Additionally, prior to using the BillingBuilder for billing processing, you must complete several other setup steps, including configuration of the payers your agency bills to, as well as configuration of billing types, procedures, program billing groups, program billing information, and rates. (Information on this setup process is discussed here.) Once your agency has completed that billing setup process you will be ready to begin billing processing from AWARDS.
The BillingBuilder and its processing components are available to users with the following permissions:
Display Executive Administration Buttons - OR - Display Fiscal Buttons (only required if you are not a member of the "Fiscal Staff" or "Executive Officer" user groups)
NOTE: Permissions are assigned using the Permissions Maintenance feature. If you do not have access to that feature and need a permission listed here, please contact your supervisor or your local Help Desk for assistance.
Entering Client Data - Learn to enter the necessary entitlement and diagnosis information for clients.
Verifying Insurance Eligibility (270/271) - Learn to verify a client's eligibility.
Generating Invoices - Learn to generate an invoice batch for a program billing group.
Working with Invoices - Learn to view, edit, delete, and print invoices.
Posting Invoices to Accounts Receivable - Learn to post invoices to A/R.
Working with Insurance Claims - Learn to create 837 claim files and HCFA paper claim forms, as well as to unpost invoices.
Submitting Claims - Learn about submitting claims outside of AWARDS.
Working with Response Files - Learn to upload and read response files from payers.
Viewing and Posting a Remittance Worksheet (835) - Learn to view/post a remittance worksheet.
Working with Reversals and Adjustments - Learn to reverse/adjust previously posted invoices.
Working with the Consumer Billing Dashboard - Learn to create payment records for self-paying clients who make co-payments or full payments for services rendered.
Frequently Asked Questions