Working with Insurance Claims







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Invoice batches must be converted to a HIPAA-compliant format to submit to most payers.  Generally, payers will accept either an 837 electronic claim file, UB-04, or a HCFA paper claim form.  Creation of claims in these formats are detailed below:

Generating an 837 Claim File

Generating a HCFA Paper Claim Form

Generating a UB-04 Paper Claim File

Unposting an Invoice Batch

To view detailed information on these processes, click the name of the process above or scroll through the content below.

Generating an 837 Claim File

To generate an 837 electronic claim file, complete the following steps:

    1. From the AWARDS Home screen, click Administration from the left-hand menu, and then click Fiscal.  The Fiscal fly-out menu is displayed.
    2. Click BillingBuilderThe BillingBuilder Menu page is displayed.  
    3. Click Create Insurance Claims.  The Create Insurance Claims page is displayed.
    4. Click the Batch Number drop-down arrow and select the batch for which a claim file is to be generated.  

  TIP: Please note, only invoice batches that have been posted to A/R are included in this drop-down.  If you are an agency involved in payer testing, click the Test File checkbox (to the right of the Create 837 Claim File button) to insert a test indicator in the 837 file (ISA15).

    1. Click Create 837 Claim File.  The Create 837 Claim File page is displayed.  
    2. Click the Click here Claim File Download link, and then click Download to acknowledge the PHI Download Alert.  A txt formatted file is now downloaded to your computer.  This file is formatted correctly for submission to any payer that accepts a HIPAA-compliant electronic claim file.  

The process of generating an 837 claim file is now complete.

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Generating a HCFA Paper Claim Form

To generate a HCFA paper claim form, complete the following steps:

    1. From the AWARDS Home screen, click Administration from the left-hand menu, and then click Fiscal.  The Fiscal fly-out menu is displayed.
    2. Click BillingBuilderThe BillingBuilder Menu page is displayed.  
    3. Click Create Insurance Claims.  The Create Insurance Claim File page is displayed.
    4. Click the Batch Number drop-down arrow and select the batch for which a claim file is to be generated. 

  TIP: Please note, only invoice batches that have been posted to A/R are included in this drop-down.  If you are an agency involved in payer testing, click the Test File checkbox (to the right of the Create HIPAA 837 Claim File button) to allow for claim files to be created for unposted batches.

    1. Check the Do not print the provider name and credentials in Box 31 checkbox to omit the name and credentials of the rendering provider in box 31 of the HCFA-1500 printable form.
    2. Click HCFA-1500 printable form.  The Data entry for HCFA printable form page is displayed.  This page lists - in data entry mode - the HCFA forms for the invoices contained in the selected batch. 

  NOTE: One HCFA form is generated per invoice in the batch.  For example, if there are 30 invoices in the batch, 30 forms are displayed on this page. 

    1. Enter or update information on the forms as necessary.  AWARDS will have pre-populated the forms with any information available from the client's chart records, including the client's name, date of birth, gender, and insurance ID number.  The date of service, procedure code, diagnosis code, and rate for the procedure being billed will also have been filled in automatically.  

  NOTE: Any information manually entered on the HCFA form is NOT saved in AWARDS once you return to the Billing Menu page. 

    1. At the bottom of the page, select the Data Only checkbox if you are using an actual CMS HCFA 1500 claim form when printing.  This will just print the form data and not the form columns and labels.
    2. Once any needed updates are complete, click 1500 Printable Form on the bottom of the page.  The forms are displayed in a printer-friendly format.
    3. Use your browser's Print option to print the invoices.  

  NOTE: Page breaks are automatically inserted between each invoice when printing. 

    1. Click the browser's Back button to return to the Data entry for HCFA printable form page.
    2. Click one of the navigation buttons that appear on the bottom of the page, to navigate away from the claim file, such as BillingBuilder or Home

The process of generating a HCFA paper claim form is now complete. 

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Generating a UB-04 Paper Claim Form

To generate a UB-04 paper claim file, complete the following steps:

    1. From the AWARDS Home screen, click Administration from the left-hand menu, and then click Fiscal.  The Fiscal fly-out menu is displayed.
    2. Click BillingBuilderThe BillingBuilder Menu page is displayed.
    3. Click Create Insurance Claims.  The Create Insurance Claim File page is displayed.
    4. Click the Batch Number drop-down arrow and select the batch for which a claim file is to be generated.  

  TIP: Please note, only invoice batches that have been posted to A/R are included in this drop-down.  If you are an agency involved in payer testing, click the Test File checkbox (to the right of the Create HIPAA 837 Claim File button) to allow for claim files to be created for unposted batches.

    1. Click UB-04 printable form.  The Data entry for UB-04 printable form page is displayed.  This page lists - in data entry mode - the UB-04 forms for the invoices contained in the selected batch.

  NOTE: One form is generated per invoice in the batch.  For example, if there are 30 invoices in the batch, 30 forms are displayed on this page. 

    1. Enter or update information on the forms as necessary.  AWARDS will have pre-populated the forms with any information available from the client's chart records, including the client's name, date of birth, gender, and insurance ID number.  The date of service, procedure code, diagnosis code, and rate for the procedure being billed will also have been filled in automatically.

  NOTE: Any information manually entered on the UB-04 form is NOT saved in AWARDS once you return to the Billing Menu page. 

    1. Once any needed updates are complete, click UB-04 Printable Form on the bottom of the page.  The forms are displayed in a printer-friendly format.
    2. Use your browser's Print option to print the invoices.

  NOTE: Page breaks are automatically inserted between each invoice when printing. 

    1. Click the browser's Back button to return to the Data entry for UB-04 printable form page.
    2. Click one of the navigation buttons that appear on the bottom of the page, to navigate away from the claim file, such as BillingBuilder or Home.

The process of generating a UB-04 claim form is now complete.

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Unposting an Invoice Batch

WARNING! Only invoice batches that do not have remittance information uploaded into AWARDS and/or payment and adjustments applied to invoices can be unposted.  In addition, when a futures batch (Generate Previously Ineligible Batch, Generate Claim Denials Re-Billing Batch, Generate COB Remainders Re-Billing Batch, Generate Denials and Remainders Re-Billing Batch, and Generate All Futures Batch) has been posted to A/R, it cannot be unposted.

To unpost an invoice batch, complete the following steps:

    1. From the AWARDS Home screen, from the left-hand menu click Administration, and then click Fiscal.  The Fiscal Reports Menu page is displayed.
    2. Click Billing BillingBuilder.  The BillingBuilder Menu page is displayed.
    3. Click Create Insurance Claims.  The Create Insurance Claim File page is displayed.
    4. Click the Batch Number drop-down arrow and select the batch to be unposted.

  TIP: Please note, only invoice batches that have been posted to A/R are included in this drop-down.  If you are an agency involved in payer testing, click the Test File checkbox (to the right of the Create HIPAA 837 Claim File button) to allow for claim files to be created for unposted batches.

    1. Click UNPOST BATCH.  A confirmation page is displayed, confirming that the batch has been unposted.

The process of unposting an invoice batch is now complete.

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