Claim Edits [Beta]

  • Updated

This feature is currently in development and only available to a select number of users.

Avea is developing a new feature that allows permissioned users to edit box fields within a claim in the Submit tab. This enhancement enables billers to quickly update claim data before submission to ensure claims are processed quickly and accurately in the event where account configuration or claim rules cannot meet a unique billing case. 

Best Practice: We recommend account, service, and claim rule configurations are used as the primary method for institutionalizing billing requirements for automated bulk claim creation. Claim Edits should only be used in the event where one-off claim content changes are needed. 

Users and Permissions

Only user profiles at the Managing Organization level will be able to edit claims. Managing Organization Admins will not require additional permissions to edit claims. However, Managing Organization Users will require permission to edit claims.

    1. To enable the ability to edit claims, navigate to Managing Organization Admin > Users.
    2. Select the user profile whose permissions you wish to enable. 
    3. In the profile, select Permissions then Edit.
    4. Under Insurance Claims Access, update the dropdown to Edit.
       
    5. Next, toggle-on Can Edit Claims.
    6. Select Save to complete the process. 

Editable Boxes

Since this feature is currently in development, the number of boxes that can be edited is limited at this time. However, as this feature develops, additional boxes will become editable and added to the list below.

Claim Edit Workflow

At Avea, we understand how important it is for our clients to make even the smallest of changes quickly and efficiently. Let's review the best way to generate an editable claim. 

  • Let's review how to use the Claim Edit tool for new claims.

    1. Record and Submit the Attendance.
    2. Create the New Claims.
    3. Under the Submit Claims tab, locate the newly created claim.
    4. Select Edit Claim Form to open up the edit feature.
       
    5. Locate the box number of the line item you wish to change and update the information.
    6. After the desired changes have been input, select Save Changes to finish editing the claim.
    7. Once all desired claim(s) have been edited, select Submit Claims to complete the process. 
  • Let's review how to use the Claim Edit tool for corrected claims.

    1. Generate the Corrected Claim
    2. After generating the correction, navigate to the Work Center > Insurance Billing > Submit Claims section.
    3. Locate the newly corrected claim and select Edit Claim Form to open up the edit feature.
    4. Locate the box number of the line item you wish to change and update the information.
    5. After the desired changes have been input, select Save Changes to finish editing the claim.
    6. After the edits have been made, select Submit Claims to complete the process. 
  • If a claim needs a single line item changed but nothing else, the edit feature can be utilized by Resubmitting the claim without any changes. 

    1. Generate the resubmission using the process outlined here. 
    2. After generating the resubmission, navigate to the Work Center > Insurance Billing > Submit Claims section.
    3. Locate the Resubmitted claim and Edit Claim Form to open up the edit feature.
    4. Locate the box number of the line item you wish to change and update the information.
    5. After the desired changes have been input, select Save Changes to finish editing the claim.
    6. After the edits have been made, select Submit Claims to complete the process. 

Managing Edited Claims

Our Claim Edit feature is currently undergoing Alpha testing. This means that we are still in the early stages of testing and developing this feature before releasing it as a beta version.  Currently, when an edit is made, the system will automatically generate a note that can be viewed in the Work Claim section.

It is important to note that the system does not specify the exact edit was made nor does it save the change for future edits. Any edits made on a previous instance of a claim will need to be repeated for future instances. As a best practice, we recommend creating a claim note to specify what exact change was made.

  1. To make a claim note, select the claim number to open the Work Claim screen.
  2. Under Notes, we can see the user-generated edit has been noted but not specified.
  3. Select Create Claim Note.
  4. In the Text field, note the changes made using the claim edit tool.
  5. After inputting your changes, select Create to create the note.
  6. After selecting Create, the Work Claim screen should refresh and confirm the note was created with a notification in the upper-right corner of the screen. 

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