Claim Status Report (By Service Date)

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The Claim Status Report - By Service Date breaks down a claim by showing each service on a separate line, with one line per service line of each claim. This report is highly customizable due to the numerous available data points and the option to customize the included columns.

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, select Claim Status Report (By Service Date.)

      3. Update the filters to create criteria the system can use to identify which claims will be included in the report. 
      4. 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. Select Create Report.
      6. The system will then automatically download the report to your system in a excel format. 

Available Filters and Definitions

  • The Date Type instructs the system to look for claims who have a date-type that falls within the selected dated range.
     
  • The Start Date and End Date establish a timeframe for the system to locate and include qualifying claims.
  • 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 input the patient's full name to display line items only of claims that patient.
  • 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, or Private Pay patient.
  • The Selected Practices filter allows users to filter search results based on the practice that claims were submitted under.

Available Columns and Definitions

  • Column

    Description

    A/R Classification

    The A/R Classification chosen on the treatment episode. This can either be Insurance, Private Pay, or Mixed Insurance/Private Pay. Found on Patient > Treatment Episode > Intake > Admit/Discharge

    Additional Patient Responsibility

    This is the total amount of PR 45 code amount 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

    Admit Date

    The date the patient was admitted for this treatment episode

    Assigned User

    Assigned user 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 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

    The AveaOffice assigned Treatment Episode Number. This can be found in Patient > Treatment Episodes

    Charges

    Amount charged

    Check Number

    Number displayed on the payment collection

    Claim ID

    AveaOffice or Legacy claim number

    Claim Issues

    The most recent issue source and type chosen for the resubmission or correction for 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.

    This can be found in Patient > Treatment Episode > Insurance Billing or Patient > Treatment Episode > Insurance Billing > Claim > Workflow

    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.

    This can be found in Patient > Treatment Episode > Insurance Billing or Patient > Treatment Episode > Insurance Billing > Claim > Workflow

    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

    Payment Date listed on the payment collection

    Date Treatment Recorded 

    Date that the service was added to the Attendance Calendar

    Date Treatment Submitted to Billing 

    Date that the service was Submitted to Billing from the Attendance calendar for claim creation

    Dates(s) Payments(s) Deposited

    Deposit Date entered on the payment collection

     

    Date(s) Payment(s) Posted

    Post Date listed on the payment collection

    Days Outstanding

    Number of days since the claim was submitted from AveaOffice

    Days to Close 

    Number of days the claim was open before being assigned a Closed state

    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
    Expected 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 the Practice. 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. 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 versus 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
    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

    HCPCS Code

    Procedure code billed on the claim, if any.

    Home Plan Payer

    Payer listed in the Home Plan carve-out of the patient's insurance set

    Insurance Balance

    Calculation of the (ChargeAmount - PaidToFacilityAmount - 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)

    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 Avea or Legacy if the claim was imported from a previous system.

    Paid Amounts

    Sum of Paid to Facility + Interest + Paid to Patient amounts

    Paid to Facility

    Amount paid to 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 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 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
    Procedure Code This is the HCPCS or CPT 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. 

    Submitted Date

    Date the claim instance was submitted to the clearinghouse for processing
    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

Viewing the Report

The Claim Status Report (By Service Date) downloads as an Excel file and produces a table where each row represents a single service date, and each column contains different information about that service date. To view an example of this report, click here.

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