Best Practices for Billers

This article provides a detailed process overview for the billing team, covering the various steps involved in claim creation, rejections management, corrections, and submission. This comprehensive workflow ensures that claims are handled efficiently and submitted to the payer with accurate data, helping the team meet their goal of quick payment processing, reliable revenue projections, and smooth follow-up by the collections team.

Audience

• Billers are responsible for marking attendance and submitting treatments to billing for new claim creation. If part of a larger billing team, additional duties include ensuring timely changes to claim data in order to create corrected claims and managing the rejections queue and workflow
• Team Leads will also serve as subject matter experts in their particular department/area and ensure process adherence, working closely with the Billing Managers to surface day-to-day challenges and suggest modifications to the Avea configuration based on their own experiences and the experiences of their team. 
• Billing Team Leads are responsible for selecting the appropriate treatments for claim creation, ensuring the quality of the data on new and corrected claims before submitting claims for processing on to the payer and supporting your team with admin-level configuration changes.

Steps for claim creation, claim QA, claim submission and admin-level configuration may be performed by the same individual(s) depending on the organization of your team and user permissions/span.

Process Overview

Role	Daily	Weekly
Billers	Kicking off the billing cycle Marking treatments in the Attendance calendar Working Rejections and Corrections Reviewing and managing claim rejections Reviewing and resolving claim corrections	Pushing new services toward claim creation Submitting Treatments to Billing

Billers Daily Tasks

Let's review a biller's daily tasks together! 

• Updating the Attendance Calendar with treatment marks every day helps you and your team expedite the review and submission process for billing at the end of the week. This practice also allows you more time each day to handle any corrections or rejections that may be delaying the processing of already submitted claims. For more information on recording attendance, click here. 
  

  Step	Action	Tips and Notes
  Navigating the Attendance Calendar	Go to the Attendance tab, located on the left side of the navigation bar below Patients	The Attendance calendar defaults to the current week. Be sure the correct week is displayed before adding treatments. Use the Filter by Payer drop down to only display patients who have the selected payer entered as the behavioral payer in their insurance set. This can allow for quicker billing by known payer conditions.
  Mark UR-required services	Auto-Fill: Click the Auto-fill link below the patient’s name to add a UR planned service to each available day in the calendar.	Use the Auto-Fill link to check the UR plan’s authorization status and save time adding services. If a single date is not needed, simply remove it. Escalate any questions you make have about auth status to the UR manager and/or team lead.
  Mark Standalone Services	Click the dropdown on the patient’s row below the appropriate date to create a standalone service or combined service set.	The facility you choose will dictate what services are available to bill. Add ICD codes in the order they should display on the claim, with Admitting code first.

• Accurate claims processing is essential in the billing workflow. While rejections and corrections can often be resolved quickly, some may need escalation to a team lead, billing manager, UR manager, or RCM Support. It’s important to review these daily to facilitate prompt resubmission, as delays can hinder payment.
  

  Step	Action	Tips and Notes
  Reviewing rejections	Go to Work Center > Insurance Claims > Currently Rejected/Held Claims Sort the list by payer or patient, and investigate the rejection reason by reviewing the claim’s Processing Events	Claim Rejected by Payer is a rejection message sent from the Payer’s system. Claim Rejected by First/Second Edits is a rejection message sent from the clearinghouse. A Held claim is not rejected, instead, it is held by the payer for processing often for needing additional documentation. The Details column under the Processing Events tab will cite the exact reason the claim is rejected.
  Addressing the reason for the rejection	Make changes you are permitted to make in AveaOffice to fix the claim Escalate to UR Manager for UR plan edits Escalate to Team Lead for admin-level setting changes Escalate to AveaOffice Support when rejection details are unclear	Common rejections and how to resolve them are documented in the Help Center Depending on your level of permission, you may need the help of other team members to make changes to UR plans or other billing information.
  Add notes to the claim	Go to the Notes sub-tab in the claim’s Work Claim tab and click Create Claim Note	It’s important to document any work you are doing or steps you are taking to update a claim. See The Avea Way - Best Practices for Updating Claim Workflow
  Create a follow-up instance of the claim: No Changes or Create a follow-up instance of the claim: Correction	When no change to the claim’s data was needed: Go to Patient’s Name > Insurance Billing > Claims and click on the Resubmit link next to the claim ID. or When data on the claim was changed to address the rejection reason: Go to Patient’s Name > Insurance Billing > Review Corrections and click on the Check for Corrections button, then confirm.	It’s important you choose the best Issue Source and Issue Type when resubmitting a claim with No Changes or resolving a correction, as it adds context for your team to understand the issues that have affected the claim. If the correct Issue is not available, ask your Team Lead or Billing Manager to create the appropriate Issue for you to select.

•  Effectively managing the resubmission workflow supports team members and helps leads and managers by providing context through Claim Notes and Issue tags, which highlight the problems affecting processing.

  Step	Action	Tips and Notes
  Reviewing Corrections	Go to Work Center > Insurance Claims > Create Corrected Claims Sort the list by Patient and note the type of correction. Click on the Compare link to view what data on the claim is changing	When comparing data, give special attention to the red highlighted lines. If a claim ID on a correction line is prefaced by [New] from Claim ID, then a claim split has occurred to move dates of service away from the original claim to a New claim. You must resolve both claim lines to complete the workflow.
  Resolving corrections	Click the Resolve link on the claim correction line to open the correction form. Complete the form from top to bottom.	Claims with an ICN displayed may have a remit posted or were previously corrected. Claims without an ICN displayed may not have been adjudicated yet or reached the payer. After completing the form, click the Resolve button to send the claim correction to the Submit queue, but stay on the current page to continue resolving corrections. Click the Resolve and go to Submit Claims only when resolving the last correction you intend to work on and navigate away from the corrections list.

   

Billers Weekly Task

Let's review a biller's weekly task together! 

• Submitting treatments to billing from the attendance calendar weekly ensures a regular schedule for billing new claims. This lets your organization reliably plan for claims follow-up and project incoming revenue.

  Step	Action	Tips and Notes
  Review all marked treatments	Go to Attendance > Unsubmitted Attendance Review the dates of service and services marked for each patient displayed	Run a new report in the EHR/EMR to compare against marked services and review to see if any changes were made to treatment notes.
  Push marked services to claim creation queue	Use the Select None/Select All buttons, the Toggle link below the patient’s name, or checkmark boxes above each service to select services. Click the Submit Treatments for Billing button	Submitting treatments to billing from this tab allows you to view and submit for more than one week at a time in one table.