Claim Submission Report

  • Updated

The Claim Submission Report is one of the most utilized reports in AveaOffice. It shows all claims that have been submitted for a given period of time. Comparing submissions month over month can be a good indication of growth. The Claim Submission Report can also be used to forecast revenue for the coming months.

Creating the Report

Go to the Reporting section from the left-side menu. This Report is available at both the Organization and Managing Organization level. Under Attendance Reports, select Claim Submission Report.

Organization vs Managing Organization

Organization: Running the report from the Organization level allows the user to select one or more Practices under an Organization and will include all facilities under the selected Practices.
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Managing Organization: Running the report from the Managing Organization level allows the user to select one or more Organizations and will include all Practices and Facilities under the selected Organizations. 
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Report Settings

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Selected Practices

The Claim Submission Report can be run at the Managing Organization, Organization, or Practice level.

In the Managing Organization version of the Claim Submission Report, the options are to run for the entire Managing Organization or to select one or more Organizations.

In the Organization version of the Claim Submission Report, the report can be run for some or all practices.

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Include Manual Claims

This is a toggle yes or no option.

Manual or legacy claims were not originally submitted through AveaOffice. This setting is defaulted to No. To include manual, or legacy, claims in the report, move the toggle to Yes.

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Date Range

Start Date & End Date

The report will pull all claims within the selected date range. The date range is controlled by the Date Type field explained below.

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Date Type 

Submission Date - show all claims that were submitted within the date range specified above.

Service Date - show all claims with dates of service within the specified date range.

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Show The Show field has the most variation and determines what kind of claims are shown in the report. See below for more on Show. mceclip3.png
Patient Identifier Display

(None), Medical Record Number (MRN), & Patient ID

(None) is the default selection.

Selecting either Medical Record Number or Patient ID will add an additional column to the report before the Claim ID with that information.

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Payer Name Display

This option determines which payer name will appear in the Payer column of the report.

The two options are Claim Payer and Home Plan Payer. The claim payer is the payer that the claim was sent to, be it the medical or behavioral payer. Home Plan Payer is the payer name in the Home Plan Payer field in a patient’s insurance set.

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Show

  • Only original (1.1) claims, the default option, refers to the first instance of a given claim. With that option selected, the report will only show bran new claims, and all Avea claim IDs pulled in the report will end in -1.1.
  • Only Resubmitted (1.x, 2.x, 3.x) Claims refers to any claims that are not the original claim instances. When that option is selected, the report will pull all corrected claims and claims that are resubmitted without changes. The Avea claim IDs pulled in the report will end with a number greater than or equal to 2.
  • Only secondary/tertiary claims (x.1) refers to the first instance of a given claim that goes to a secondary or tertiary payer. When this option is selected, the report will only show claims that have already been processed by the primary payer. The Avea Claim IDs pulled in the report will have a penultimate digit that is either 2 or 3.
  • All Submitted claims refers to every single claim instance that was submitted in the date range including all new claims, corrections, resubmissions, and secondary/tertiary claims. Running the report this way guarantees that no claim instance is left out. The report will show duplicate charges if multiple instances of the same claim were submitted in the time period.
  • Most Recent Claim refers to the instance of the claim that was submitted most recently. When this option is selected, the report will show every claim that was submitted in the date range, without any duplicates. If both an original 1.1 claim and a corrected 1.2 version are submitted, the report will only show the 1.2 version.
  • Not submitted refers to all claim instances that have been created, but not submitted. This pulls claim instances from the Submit Claims tab in the Work Center. Claims on this report will not have information dependent on submission, like submitted date.
  • All submitted claims & dates not submitted refers to a sum of both the All Submitted Claims report and the Not submitted report

 

Generating the Report - Run Report, Refresh Data, and Download

Organization Level - Report data will display in AveaOffice with the option to download a CSV that can be viewed in Excel. This in-app view allows the user to run the report, then refresh the data without having to run another report.

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  • Run Report - Click Run Report to generate a report using to the selected settings
  • Refresh Data - To improve report speed, report and dashboard data is cached up to the last 24 hours. To use real-time data, click Refresh Data to update reports results using the most recent data.
    Pro Tip: Hover your cursor over time stamp below the Totals section to see the last time data was refreshed
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  • Download - Choose Download to export the report data as CSV. Your CSV file can be opened with Excel or other desktop app

 

Managing Organization Level - Reports will run in the background and a download link will be sent to the requesting user from Avea Solutions.

  1. After clicking Create Report,
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  2.  A message will indicate that the report will be sent to your email to download once it's ready.
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  3. Check your email for a link to the report.
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  4. Reports can also be found under the Records Center > Documents > Managing Organization Documents for download.
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Results

The Claim Submission Report produces a table where each row represents a single claim, and each column is a different piece of information about that claim.

Columns
Source | Submitted Date | Patient | Medical Record Number | Patient ID | Claim ID | Version | Sequence | Submission Type | Claim Type | Service Start Date | Service End Date | Units | Service | Charges | Expected Allowed Amount | Claim Payer | Home Plan Payer | Organization | Practice | Facility | Network Type | Payer Status 

Totals: Totals are displayed at the top of the in-app display and on the last row of the downloaded report.

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Report Column Definitions

Source

This shows where the claim came from. There are two possibilities: Office and Manual. Office in that column means that the claim was submitted through the claim submission process in AveaOffice. Manual means that the claim was created manually as a legacy claim.

Submitted Date The date the claim was submitted from AveaOffice to the clearinghouse. 
Patient The name of the patient associated with the claim. 
Medical Record Number The patient's medical record number.  This is manually entered in Treatment Episode > Admit/Discharge. 
Patient ID The patient's ID number.  This is manually entered into Patient > Profile. 
Claim ID The AveaOffice-assigned claim number identifier
Version The claim instance number (x.1, x.2, x.3, x.4, etc)
Sequence
  • Primary
  • Secondary
  • Tertiary
  • Guarantor (Inbox Health only)
Patient Identifier This will either be the MRN or Patient ID, depending on which one was chosen when creating the report. If (None) was selected, then this column will not be in the report.
Submission Type This indicates if this is a new claim or a corrected claim.
Claim Type
  • Institutional
  • Professional
Service Start Date The service start date of the claim
Service End Date The service end date of the claim
Units The number of units on the claim
Service The service billed on the claim
Charges The charge amount billed on the claim
Expected Allowed Amount This is the amount that the provider can anticipate being covered by the payer. This number is determined by what has been entered under Payer Rates in Practice Configuration. If there are no payer rates set for this payer and service, then this number will default to the total billed charges of the claim.
Claim Payer The Medical or Behavioral payer the claim was sent to in Treatment Episode > Insurance
Home Plan Payer The payer listed as the Home Plan Payer in Treatment Episode > Insurance
Organization The Organization of the claim
Practice The Practice of the claim
Facility The Facility of the claim
Network Type
  • In-Network
  • Out-of-Network
Payer Status The status of the claim submission to the clearinghouse.
Claim Method
  • Electronic
  • Paper
Claim Attachments Indicates if the claim was sent with or without attachments
  • With Attachments = Yes
  • Without Attachments = No

Tips and Tricks

Search by patient name and claim ID to filter the report without having to download it to excel.

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