Create Claims

After Attendance has been recorded and submitted, the system will route the submitted treatments to the Work Center where the submitted treatments will be created into claims and submitted to the payer. 

Create New Claims

The Create New Claims tab makes filtering, selecting, and converting submitted treatments into new claims easy. Let's review each feature together! 

Available Filters

• The Practice filter groups submitted treatments by the practice associated with the patient's treatment episode. Practices with submitted treatments that have not yet been created into claims will have a star icon next to their name.
  
• The Show filter groups submitted treatments by those With Errors or those with No Errors.
  
• The Payer filter groups submitted treatments by their common payer. 
   
• The Level of Care filter groups submitted treatments by the Level of Care identified in the Service Billing Profile. 
  
• The Date Range filter groups submitted treatments based on their service date within the last two months.
  

Claim Creation Workflow

Let's review how to Create a New Claim! 

• 1. Navigate to the Work Center and click on Insurance Claims.
     
  2. Next, click Create New Claims.
     
  3. Select the treatments that you'd like to be included in the claim.
      
  4. Finally, click Create New Claims for Selected Treatments.
      

Common Errors and Resolutions 

Sometimes a newly submitted treatment cannot be converted to a claim until a piece of information within the claim is updated/included. When this occurs, an error message will be displayed instead of the dates of service. Let's review those errors together and how to resolve them.

Error	Definition	Resolution
Facility [Name] does not reference Service [Name]	This means the service recorded has not been referenced at the facility level.	Navigate to the Practice Admin > Facilities > Facility > Facility Service Rates to reference the service.
No Insurance Set is effective on X/X/XXXX to cover recorded treatment.	This means at least one service date occurs before the effective date or after the termination date within the insurance set.	Navigate to Treatment Episode > Intake > Insurance to input a new insurance set or update either the effective or termination date.
Treatment Episode Must Have a Completed Profile	This means a key piece of information is missing from the patient's profile.	Navigate to Patient > Treatment Episode > Intake > Patient Profile and update the missing information.
Treatment Episode must have an ICD-10 Admitting/Principal Diagnosis.	This means one or both diagnoses are missing from the patient profile.	Navigate to Patient > Treatment Episode > Intake > Behavorial Service  Diagnosis and set the diagnosis.

Helpful Hints

• Yes! To create claims on a patient-by-patient basis, click the Select All box to unselect all patients.
  
• Yes! The system will default to selecting all dates of service that are not yet part of a claim. To omit certain dates, click the box next to the service to uncheck it and omit it from the next batch.