Create Paper Claims

While most payers accept electronic claims, some do not and require a paper claim to be mailed. Unlike electronic claims, paper claims often take two or more months to be fully received, adjudicated, and paid. Kipu RCM offers users multiple workflows for creating paper claims. Let's review how and where paper claims can be made in the RCM!

User Permissions

Admin-level users can create paper claims without requiring additional permissions. User-level profiles required additional permissions to be configured to generate paper claims.  For more information on user profiles and permissions, click here. 

Paper Claims in the RCM

There are four methods available for creating a paper claim; however, as a best practice, we recommend using a paper payer. Let's review the methods together and see which works best for you! 

• Paper Payers are created in the Practice Admin > Insurance Payers section of the RCM. Paper payer profiles differ from electronic payer profiles because they require a physical mailing address to be included in the profile. This address is where the claim will be mailed, so it is essential to verify that you have the correct information. For more information on creating paper payers, click here.
• 1. Resubmissions are generated in the patient profile by navigating to Patient > Treatment Episodes > Insurance Billing > Claims.
     
  2. Resubmitted claims can be converted to paper claims by clicking Resubmit.
     
  3. And clicking the toggle to force the claim to paper
      
• Corrections are generated when something present on the current instance of the claim has changed and requires review. Corrected claims can be converted to paper claims by clicking on the toggle to force the claim to paper.
• A Service Grouping Rule is available to convert electronic claims to paper claims depending on the service and conditions set within the rule. It is essential to note that the electronic payer profile (or the Policy Holder section of the patient's insurance set) must include a physical mailing address for the rule to function correctly.
   

Commonly Asked Questions

• Unlike electronic claims, paper claims can take 60 to 120 days or more to be fully adjudicated. This timeline varies from payer to payer and often requires more follow-up to ensure the claim is being processed accordingly. 
  
• Since paper claims do not receive updated processing events once the claim has been printed and mailed, the RCM cannot provide information about the status of the claim. We recommend calling the payer (or using the portal if available) every 15-20 business days to confirm receipt of the claim. 
• A PoTF is issued the day the paper claim is entered into the payer's system and is usually mailed within two to four weeks of receiving the claim. If a PoTF is needed, we recommend using the payer portal when available or calling the payer directly.
• If it has been over 30 days and the payer says they still have not received the claims, please note the name, phone number called, and reference number provided and reach out to our support team at [e-mail]. With that information, a case can be opened with the clearinghouse to obtain the tracking number of the submitted paper claims. Please note it may take up to 10 business days to obtain these numbers. We would recommend that you resubmit the claims or print and mail them in-house in the meantime. 
• Yes! Click here for more information on printing claims from the RCM.