Submit Claims

Once a claim has been created, the system will redirect the new claim to the Submit Claims tab within the Work Center. Let's review the features of this section and how we can submit those claims to the payer!

Available Filters

• The Practice filter allows a user to sort unsubmitted claims by the practice with which the patient's treatment episode is associated. Practices with ** to their name indicate there are unsubmitted claims within that practice.
  
• The Payer filter displays unsubmitted claims by their common behavioral payer.
   

Review Claims before Submission

Once a claim has been created, it is important to review the contents of the claim before submission. Let's go over the different ways the information can be verified!  

Columns and their Definitions

Column Name	Definition
Claim	This is the internal claim number assigned by the system. Clicking on the hyperlink will generate the Work Claim screen.
Type	This identifies the claim type: Institutional or Professional.
Method	The method identifies how the claim will be delivered to the payer: Electronic or Paper.
Context	The context provides additional details about the claims' origin. New: The claim has not been submitted to the payer.  Correction: The claim has been sent to the payer at least once and now has updated contents. Resubmission (No Changes): The claim has been sent to the payer previously and is now being sent again with the same contents as the previous submission.
Created	This is the day the claim (or correction) was created.
Patient	This is the name of the patient on the claim. Clicking on the hyperlink will open the Admit/Discharge section of the patient's treatment episode.
Dates of Service	This identifies the first date of service and the last date of service on the claim.
Payer	This is the name of the payer the claim will be submitted to.
Amount	This is the sum of all charges on the claim.
Errors	This identifies any errors found within the claim that needs to be corrected before deleting and recreating the claim.

Quick Links 

• The View quick link displays a window with the EDI information the claim is being created with. Using the View options provides the most accurate information about what will be included in the claim and its corresponding box.
   
• This link is only available for Professional claims and allows a user to represent amounts paid by the patient or other payers for Medicare-covered services.
   
• The Delete quick link will delete the claim and send the dates of service back to the Create New Claims tab to allow for recreation.
   
• The Preview quick link will generate a PDF preview of the claim as it would appear on the claim form. On occasion, the information may slightly differ from the actual claim form so it is recommended to default to using the View quick link to ensure accuracy.
   
• Add Remarks is only available for Institutional Claims and allows a user to include remarks in Box 80 to the payer. This field only supports 24 characters per line; longer entries will need to be manually broken up.
  

Claim Submission Workflow

Submitting claims using the RCM has never been easier. Let's review the process together!

Workflow

• 1. Navigate to Work Center > Insurance Claims > Submit Claims section.
     
  2. Identify the claims you wish to submit to the payer.
     1. If there are claims you do not want to send, select the box next to the Claim number to omit them from the batch.
        
  3. Click Submit Claims to complete the process. 
     

Bulk Options

• Click this button to send claims to the clearinghouse for electronic processing or printing.
  
• 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.
   
• Creates a batch of PDFs that can be printed onto official claim forms using your printer. This button only appears when enabled for your facility. For more information on printing claims, click here.
   
• Click this button to delete all selected claims.
  

Claim Submission Errors

Occasionally, a user will encounter an error when submitting claims. For more information about common submission errors and how to fix them, click here. 

Helpful Hints

• Newly created claims will be highlighted in green to help identify them more easily.
  
• All submitted claims can be found in the Record Center under Insurance Claims > Claims or Batches, regardless of the submission method used.  For more information, click here.