Anyone with Billing Permissions with the ability to submit claims to the clearinghouse can view the claims process.
Before You Begin
The below process is for users have signed and agreed to the Terms and Services with Apex Clearinghouse. If you have not signed those Terms and Services under Organization > Claims Service then you will not see all the below tabs.
- Once an invoice has been created it can be added to Awaiting Submission. This is when it will become a claim.
- In Awaiting Submission claims can be checked for common errors such as date of birth, gender, address, diagnostic code, etc. If a claim has no errors it can be submitted to the Clearinghouse.
- Once a claim is at the clearinghouse it will be checked for errors again. If it gets rejected at the clearinghouse the claim will appear in the rejected/denied tab. You will be able to see the reason and make changes and resubmit the failed claim.
- If all is well with the claim the clearinghouse will pass it on to the payer. This is when your claim will move from the Submitted tab to Accepted.
- The claim will stay in the Accepted tab till it is manually marked as paid. You will want to change the status of the claim after receiving ERA payment and move it to the Paid/Processed tab. If the claim is rejected or denied by the payer it will automatically move to that respected tab.
Manually Update Status
You can manually update and change the status of claims. You'll see this on every tab excepted for the Processed/Paid tab. The only option on the Processed/Paid tab is to remove the claim which will push the claim back to Awaiting Submission.
Adjust Date Range
To prevent performance issues we've limited the date range of the tabs.
Submitted & Paid can be pulled in 3 month increments.
Rejected/Denied, Resubmitted, and Accepted can be pulled in 6 month increments.
You can include addition columns of information in the tab by customizing the grid. Mark the box next to the columns you wish to include and your information will update.
Search to Filter
Any column that says "search to filter" means you can search in that column for specific information. A specific client, payer, service date, or CPT code. When you filter you'll see that your results will update in the top right.
Every tab includes the option to export the displayed information to CSV or PDF. Again, only the display information will export when you click that option.
Claim Status Report
If you want to use the Claim Status Report you can access it on the Submitted, Rejected/Denied, and Resubmitted tab.