Creating and Submitting Claims

  • Updated

Let's review the process for creating new claims and how to submit them. We'll also cover the different claim submission options and bulk functions.

Creating New Claims 

Once attendance has been submitted for billing, you can create and submit claims.

  1. To create new claims, head to the Work Center and click on the Insurance Claims tab and then open Create New Claims.
  2. The Practice drop-down displays all available practices. Those with treatments that are ready to be combined and turned into claims will have two asterisks at the end of their name (**).
  3. Choose the desired Practice from the drop-down to load treatments ready for claim creation. All the dates of service that have been submitted for billing will display for the selected practice.
    1. New patients who have never submitted claims will be highlighted in red/pink.
  4. Each row contains the services for one patient and quick links that allow you to perform actions.
    • Click on the patient's Last Name, First Name to open the Intake tab of the patient's treatment episode.
    • Click on [Toggle] ­to deselect and reselect all dates of service for the patient.
    • Click on [Eligibility] to open a new tab with the patient's Primary (and Secondary) electronic eligibility for their current treatment episode.
  5. Once treatments are selected, click Create New Claims for Selected Treatments to create new claims. AveaOffice will automatically redirect to the Submit Claims screen.
  6. AveaOffice will automatically redirect to the Submit Claims tab.

Submitting Claims 

You can review and submit claims from the Submit Claims tab. The Submit Claims tab is located in the Work Center > Insurance Claims

The Practice dropdown displays all available Practices. Those with claims ready to be submitted will have two asterisks at the end of their name (**).

  • Choose the desired practice from the dropdown to load created claims ready for review and submission.
  • All dates of service that were submitted for billing and claim creation will display for the selected practice.

Reviewing Claims Before Submission

As a best practice, complete a quality check on the claims before submission. Newly created claims will be highlighted in green, while previously created claims will be grey.

You can sort the claim list by clicking on the title of the column. Available columns include:

  • Claim: The AveaOffice claim number is used for internal tracking of claims. Each claim ID is unique, contains an abbreviation for the practice name, a unique ID, and is appended with an instance number. The first number indicates whether the claim is going out to the primary, secondary, or tertiary, and the section number is the claim's version, so a 1.1 would be a primary claim, first version.
  • Claim Type: Institutional (UB-04) or Professional (CMS-1500) claim form type.
  • Method: Paper or Electronic submission method.
  • Context: New, Correction, Resubmission (No Changes), Secondary, or Tertiary.
  • Created: The date the claim instance was created.
  • Patient: The patient’s full name: Last, First. You can click on this field to open the patient's treatment episode.
  • Dates of Service: The dates of service range of the claim.
  • Payer: The claim will be submitted to this payer.
  • Errors: Errors the system may find that will prevent claim submission.
    • If there are any errors associated with an individual claim, the row will be highlighted in pink and an error message will be displayed in red text.
    • To resolve the error, follow the instructions listed in red, delete the claims, and recreate them from Work Center > Insurance Claims > Create New Claims. If this does not fix the issue, please contact Support.

Quick Links

Quick links are displayed in blue on the far right side for each claim line allowing the user to view and manage the individual claim. The options will vary slightly between institutional and professional claims. 

  • View: Click this link to view a full list of the claim contents that will be sent to the payer. Each line on the list represents a line on the claim form
    • Tip: This list is the most accurate representation of claim information since electronic files can contain more claim information than what can be displayed in the PDF view.
  • Edit Box 29 (Professional Only): Click this link to add the amount the patient has prepaid for services. This amount will be added to Box 29 on the CMS-1500 claim form and will be sent electronically.
    • Enter the Paid Amount and click Save.
  • Delete: Click this link to delete the individual claim only. You can recreate the claim from the create new claims section as needed.
  • Preview: Click this link to view a representation of the claim's information on the 1500 (professional) or UB-04 (Institutional) claim form.
    • Note: This is only a visual representation since electronic claims are not transmitted as a PDF
  • Add Remarks (Institutional Only): Click this link to add remarks to an Institutional (UB-04) claim. The text added here will be sent to the payer in Box 80.
    • This field only supports 24 characters per line. You will need to manually break up longer entries. 

Claim Submission Options and Bulk Functions

Use the checkbox to select the claims that you want to submit or delete. Click on Select None to deselect all claims, Select All to select all claims, or click on an individual box to select or deselect an individual claim. 

After confirming information is correct on the claims, mark the claims as submitted.

  • Submit Claims: Click this button to send claims to the clearinghouse for electronic processing or printing.
  • Mark as Submitted: Click on this button to keep a record of the claim instance in AveaOffice. This function will not send claims to the clearinghouse. Click here to learn more about the Mark as Submitted workflow. 
  • Print Claims: Creates a batch of PDFs that can be printed onto official claim forms. This button only appears when enabled for your facility.
  • Delete Claims: Click this button to delete all selected claims.

Batches will process in the background. Navigate to Records Center > Insurance Claims > Batches to review any recently submitted batch.

Creating Claims and Claim Submission Video

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