Claim Submission Report

The Claim Submission Report displays all claims that have been submitted during a specified period. By comparing submissions month over month, it can provide a good indication of growth. Additionally, the report can be utilized to forecast revenue for upcoming months. 

Generating the Report

• 1. Navigate to the Reporting section.
  2. Under Attendance Reports, select Claim Submission Report.
     
  3. Update the filters to instruct the system on how to generate the report.
     
  4. Select Run Report.
     
  5. To download the report, select Download.
     
     
  6. To include data from the last 24 hours, select Refresh Data.
     

Available Filters and Definitions

• The Selected Practices filter allows users to filter search results based on the practice that claims were submitted under.
  
• The report will pull all claims within the Start Date and End Date range. The date range is controlled by the Date Type.
  
  
• The Date Type instructs the system to look for claims within the established date range based upon either the Service Date or Submission Date.
  • 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.
    
• The Show field has the most variation and determines what kind of claims are shown in the report.
  
  • 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.
  
• This option determines which payer name will appear in the Payer column of the report.
  • Claim Payer displays the name of the medical or behavioral payer to whom the claim was sent.
  • Home Plan Payer displays the name of the home plan payer to whom the claim was sent.
  
• Selecting Include Manual Claims instructs the system to include claims not originally submitted to the clearinghouse using Avea.
   

Viewing The Report

The Claim Submission Report produces a table where each row represents a single claim, and each column provides an additional piece of information about the claim. To see an example of this report, click here.

Columns and Definitions

Row Name	Definition/Calculation
Submitted Date	The date the claim was submitted from Avea 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 Patient > 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
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 Patient > Treatment Episode > Insurance > Insurance Set.
Home Plan Payer	The payer listed as the Home Plan Payer in Patient > Treatment Episode > Insurance > Insurance Set.
Organization	The Organization the claim was submitted under.
Practice	The Practice the claim was submitted under.
Facility	The Facility the claim was submitted under.
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

Helpful Hints

• Use this report in conjunction with the A/R Waterfall and Unsubmitted Treatments report to determine when the organization can anticipate to be paid and the expected amount.
• Use this report to spot-check and monitor the payer statuses like rejections. 

• Claim Submission Report - Demo.xlsx 20 KB