Creating Legacy Claims

When transitioning from a legacy billing software to AveaOffice, there may be claims that are already in process with the payer that were submitted out of the previous billing software. In AveaOffice, legacy claims can be created to track these dates of service and charges. This allows legacy charges to show on reports and the organization receives the benefits of reporting and analytics from AveaOffice for these charges as well as AveaOffice-submitted claims.

Patient: If the patient profile doesn't already exist in Avea, please follow these instructions to create an admitted treatment episode for the patient before adding the legacy claim(s).

Claim Information

Start by saving a copy of the claim as a PDF to your local computer, and open the file for easy reference. This will allow you to quickly copy the information when creating the Legacy claim in AveaOffice. You'll also need this PDF later in the process to upload into AveaOffice.

If you do not have a copy of the PDF, you will still need the following information for entering the legacy claim:

• Claim Control Number
• Date of Service Start
• Date of Service End
• Facility
• Rendering Provider
• Authorization Number (if billed with one)
• Original Submit Method
• Line Item Details
  • Service Date
  • Service Name
  • Billing Profile (Should be created in Practice Admin with original revenue code/HCPCS combinations)
  • Units
  • Charged Amount
  • Rendering Provider
  • ICD-10 Code
• Total Charges
• Date Originally Submitted to Insurance

Claim Creation

1. Go to the patient's Claims section under Insurance Billing. If the patient profile is not yet active, create the profile under the Patients section of AveaOffice and add a treatment episode.
2. Click on Create Inst Legacy Claim to create a claim billed on UB04 or Create Prof Legacy Claim to create a claim billed on CMS 1500.​
3. Complete the form from top to bottom. Be sure to upload a copy of the claim PDF and add a line for each line item date of service.​
   
   • Note: It is important to enter in the claim exactly as it was billed to the payer from the previous system since a Legacy Claim cannot be deleted once it is in the system. This means that services, rates, and other claim information needs to be created/edited to account for the legacy information. Once the claim is in AveaOffice, only corrections can be made to the claim via the normal corrections process.
4. Once all the claim data has been entered, click Create.
5. A legacy claim will automatically create for the primary payer entered in the insurance set that covers the dates of service.
   • For services that are UR required, the system will automatically create a UR plan for the dates of service and backfill the Attendance Calendar.
   • For any Standalone service, the system will backfill the Attendance Calendar.
6. A legacy claim will now display under the patient's Claim section along with any AveaOffice claim.

Payment Posting

Moving forward, you can correct and post payments against a legacy claim like any AveaOffice claim.