Claim Status Report (By Claim)

The Claim Status Report (By Claim) is similar to the Claim Status Report (By Service Date), except that the line-item details include the number of units for each service rather than defaulting to one unit per row. Users will be able to select the same column options as in the Claim Status Report By Service Date.

Generating the Report

Let's review how to create the Claim Status Report (By Service Date)! 

1. Navigate to the Reporting section.
   
2. Under Billing Reports, click Claim Status Report (By Claim).
   
3. Update the filters to define criteria the system can use to identify which claims to include in the report. 
   
4. Then select which columns you would like to include or remove from the report:
   • To add columns: Use the checkboxes to select one or more data points on the Available side. They will automatically appear on the Selected side.
     
   • To remove columns: Uncheck the selected checkbox on the Available side. 
     
   • To reorder columns: On the Selected side, click on the desired data point and drag and drop the column into the desired position.
      
5. Once complete, click Create Report.
   
6. The system will then automatically download the report to your system in an Excel format to complete the process. 

Available Filters and Definitions

• The Date Type instructs the system to look for claims that have a date type that falls within the selected date range.

  • Claim Start Date: This pulls claim data based on the earliest date of service on the claim. 
  • Claim Closed Date: Generates claim data based on the claim's closed date. 
  • Claim First Submitted Date: This will generate claim data based on the day the claim was submitted to the clearinghouse (or marked as submitted)
  • Claim Follow-Up Date: This generates claim data based on the current follow-up date of a claim. 

  

• The Start Date and End Date define the timeframe within which the system locates and includes qualifying claims whose dates of service fall within that timeframe.
  
• The Claim State filter allows users to include or omit certain claims based on their current state. The default Claim State is All, but can be updated to Closed, Discontinued, Open, or Voided.
  
• The Patient Name Filter allows a user to enter the patient's full name to display only line items for that patient's claims.
  
• The A/R Classification filter includes or omits claims based on a patient's A/R status.  The default A/R Classification is set to All, but can be updated to Insurance (Only), Mixed Insurance/Private Pay, Private Pay (Only), or Scholarship.
  
• The Selected Practices filter allows users to filter search results based on the practice under which claims were submitted.
  

Viewing the Report

This report is available for download as an Excel file. It generates a table in which each row represents a claim service, and each column contains different pieces of information about that claim. If a claim is billed under different services, there will be separate rows for the same claim, each listing the number of units rendered for each service. To view an example of this report, click here.

Available Columns and Definitions

Column	Description
A/R Classification	The A/R Classification chosen on the treatment episode. This can be either Insurance, Private Pay, or Mixed Insurance/Private Pay. Found on Patient > Treatment Episode > Intake > Admit/Discharge.
Additional Patient Responsibility	This is the sum of the PR/OA+100 adjustment codes on the payment(s).
Adjustment Group Code	This displays all group codes for payments made against the claim.
Adjustment Reason Code	This displays all adjustment reason codes for payments made against the claim.
Adjustment Reason Code Amount	This will display all adjustment reason code amounts for payments made against the claim.
Admission Date	The date the patient was admitted for this treatment episode
Admitting Diagnosis	This is the diagnosis selected at the time of admission.
Assigned User	This is the name of the user assigned to the claim.
Authorization Number	Authorization number of the claim from the respective U/R plan for the dates of service
Authorization Status	The Authorization Status is set on the utilization plan for the claim. This is either Authorized, Denied, Pending, Not Required, or Required - Not Obtained
Behavioral Plan	This is the plan name associated with the Behavioral Payer when a carveout is present.
Benefits Assignment	View the assignment of benefits to determine if the payment needs to be collected directly from the patient.  Will display as Facility or Patient based on the value set under Patient > Treatment Episode > Intake > Insurance > Insurance Set > Policy Holder > Benefits Assignment.
Billing Account Number	When a treatment episode is created, a billing account number is assigned as an additional ID for the patient.
Charges	The sum of all charges on a claim.
Check Number	This is the check number displayed on the payment collection.
Claim ID	The RCM-assigned claim number or Legacy claim number
Claim Issues	The most recent issue source and type chosen for the resubmission or correction of the claim.
Claim Payer(s)	Name of the payer associated with the payment.
Claim Queue	The current Claim Queue associated with a claim. This is part of a customized workflow used in the claim lifecycle.
Claim State	The A/R claim state. This is either Open, Closed, Voided, or Discontinued. Note: Both open and closed claims will show on the report. Open means that the claim is still on the Accounts Receivable (A/R) Report. Closed means that the claim is no longer considered receivable.
Claim Status	The current Claim Status associated with the claim. This is part of a customized workflow used in the claim lifecycle.
Claim Type	Institutional or Professional.
Closed Date	The date the claim was closed.
Co-Insurance	Amount associated with a PR 2 in the claim payment.
Co-Pay	Amount associated with a PR 3 in the claim payment.
Covered	Calculated as the sum of the (Deductible + Co-Insurance + Co-Pay + Paid to Facility + Paid to Patient).
Date of Birth	Patient's DOB.
Date(s) Paid	The entered date is listed on the payment collection.
Dates(s) Payments(s) Deposited	Deposit Date entered on the payment collection. Please note that this column will only display data when a user has manually updated the deposit date.
Date(s) Payment(s) Posted	Post Date listed on the payment collection.
Days Outstanding	Number of days since the RCM submitted the claim.
Days to Close	Number of days the claim was open before being closed.
Deductible	Amount associated with PR 1 in the claim payment.
Difference Covered vs. Expected	Calculated as the Expected Amount minus the Covered Amount. Expected Amount is entered per unit of service in the Payer's profile under Practice Admin. The expected rate defaults to the charged amount if Payer Rates have not been set in Practice Admin > Payers.
Discharge Date	Date listed as the discharged date for the patient's Treatment Episode under which the claim was billed
DOS End	This is the last date of service on the claim.
DOS Start	This is the first date of service on the claim.
Expected Amount	This is the amount the provider can expect to be covered by the payer. This number is determined by the entries under Payer Rates in the Practice. If no payer rates are set for this payer and service, this number defaults to the claim's total billed charges. This field was previously called Amt Allowed Expected. This is calculated as Expected Unit Rate x Number of Units.  When no payer rate is entered, then it is calculated as the (Facility Service Rate x Number of Units).  When a Service Rate is entered at the Patient Level (ex. single case agreement), the Expected Amount will be reported as the amount entered for the patient's service rate. In other words, the patient's service rate will override the payer profile and facility rates in the report.
Expected vs. Paid	This column shows the difference between what was expected and what the insurance company actually paid. Calculated as the Expected Amount - Paid to Facility amount.
Facility	Name of the facility under which the claim was billed
First Submitted Date	Date the first version of the claim instance was submitted to the clearinghouse for processing.
Follow-Up Date	Follow-up date of the claim
Group Number	The Group Number of the patient's insurance policy
Has Single-Case Agreement	Whether the patient has a per-service case agreement entered. This can be found under Patient > Treatment Episode > Scheduling and Utilization > Services Rates
Home Plan Payer	Payer listed in the Home Plan carve-out of the patient's insurance set
Insurance Balance	Calculation of the (ChargeAmount - Paid To Facility Amount - Deductible - CoInsurance - All Adjustments except OA and CO-45)
Last Action Date	Date the most recent action was taken on a claim
Medical Plan	This is the plan name associated with the Medical Payer when a carveout is present.
Medical Record Number	The patient's Medical Record Number (associated with the Kipu EMR for integrated clients)
Most Recent Submitted Date	This is the last time the claim was submitted/resubmitted to the payer.
Network Type	Displays as In-Network if a payer rate was applied for this service or Out-of-Network if no payer rate is present for the service.
Original Claim Source	This will display AveaOffice if the claim originated from the RCM or Legacy if the claim was imported from a previous system.
Other Diagnosis Code(s)	This includes any other applicable diagnosis code(s) included on the claim.
Paid Amounts	Sum of Paid to Facility + Interest + Paid to Patient amounts.
Paid to Facility	Amount paid to the facility as listed on the payment.
Paid to Patient	Amount paid to the patient as adjusted by code PR or OA 100 on the payment.
Patient Adjustments	This is the sum of all adjustments made by the provider to reduce the patient balance.
Patient Balance	Calculated for Closed claims as the sum of (Paid-to-Patient + Deductible + Co-Insurance + Co-Pay + Additional Patient Responsibility + any other PR reason code)
Patient ID	Internal ID number entered for the patient's profile
Patient Name	The name of the patient.
Patient Payments	This is the sum of all patient payments collected and applied to the claim.
Patient Share	Calculated for open claims with a posted payment, as the sum of (Paid-to-Patient + Deductible + Co-Insurance + Co-Pay + Additional Patient Responsibility)
Payment Source	The payment source entered on the payment collection/check. This can either be Electronic, Paper, Payer Portal, Payer Representative, Client Data Import, or Manual
Payment Type	The Payment Type is either ACH, Check, Insurance Credit Card, Non-Payment, or Reversal
Practice	Name of the Practice under which the claim was billed
Primary Payer	Name of the primary payer to which the claim was submitted
Primary Payer Claim ICN	Internal Control Number assigned to the claim or payment by the primary payer
Principal Diagnosis	This is the principal diagnosis included in the claim.
Procedure Code	This is the HCPCS or CPT code used when billing the claim.
Referral Source	This is how the patient was referred to the organization.
Rendering Provider	The attending physician listed on the claim
Revenue Code	Revenue code associated with the service as it was submitted on the claim
Service	The name of the service billed.
Service Billing Profile	Service billing profile used to generate the claim
Service Date	The date of the service
Single Case Agreement ($)	If a Single Case Agreement is present for the claim, the unit rate will be displayed; otherwise, this field will be blank.
Subscriber ID	Subscriber's member ID number as submitted on the claim. This can be found under Patient > Treatment Episode > Intake > Insurance > Payer Name > Policy Holder
Total Balance	Sum of the Insurance Balance + Patient Balance columns
Units	Total number of units of a service submitted on the claim

• Claim Status Report (By Claim) - Avea Solutions QA Org -DEMO.xlsx 20 KB