In this lesson we’ll cover the following Claim Submission topics:
- Claim Submission Folders
- Manually Changing Claim Status
- Creating a CMS 1500 - Health Insurance Claim Form
- Batch CMS-1500 Forms
All insurance claims are managed under the main “Billing” tab in Jane.
The “Claim Submissions” area found on the left, has a number folders to keep all patient claims accounted for during the submission process.
Let’s get to know a few of the Claim Submission Folders:
- The Draft folder is an optional folder used for reviewing claim information. You can set up your account so that all new claims start here. This folder can be helpful if you have dedicated billing staff who need to easily know which claims have been reviewed and are ready to be submitted. Once claims in this area are reviewed and ready to be submitted, they can then be moved to the “Unsubmitted” folder by the practitioner.
- The Unsubmitted folder holds all insurance claims ready to be submitted. This is where new EDI files are generated.
- The Submitted folder holds any claims that have been submitted, and are awaiting remittance from the insurance company.
- The Approved folder is your “Done” folder! It holds all claims that have been marked as paid or a response has been received.
If you are interested in using the draft folder as a “review” area, you’ll want to set up this default by heading over to Settings > Billing Settings > Set New Claim Submissions As… and select “Draft” from the drop-down menu.
Claim Folder Menu Options
If you are working in the Claim Submissions area, you can access claim details using the right side menu:
View Claim: Click to view the claim if you need to update the patient’s insurance policy information.
View Purchase: Click to view the purchase details. This page allows you to update the billing code information and insurance claim details attached to the visit, without having to return to the main schedule or patient profile.
You can manually change the status of a claim using the right side menu.
For example, let’s say you work with a billing team, and you’d like to review claim information before submission.
Starting in the Draft folder, once you have reviewed the claim details, you can click the right side menu and select the option “Mark as Unsubmitted.” Jane will then move this claim into the Unsubmitted Folder where the billing team can prepare the EDI for submission (more on that in the next chapter!).
Jane is able to generate a CMS 1500 form into an editable PDF for claim submission.
Once you have Arrived an appointment and have added in all insurance claim information, you can click the downward arrow next to the “Pay” button and select Generate CMS 1500:
From the Draft or Unsubmitted folder, you can also generate a CMS-1500 form by clicking the right side arrow, and selecting View Purchase,
Jane will tell you if there are any missing fields and then generate the form:
This form can now be Printed, or edited further if required. For editing, it’s best to Save the form first and then make any needed edits to the downloaded copy.
The CMS-1500 Forms will print best on blank paper and you’ll need to print in colour if the payer you are submitting to can’t process the claim if it’s displayed in black and white…
Hop into the guide below to review the information you need to ensure all the data is populated onto the form:
Note: SOF stands for Signature on File. This is an accepted term but feel free to remove this is you are printing and signing.
Want to export multiple CMS-1500 forms in one go? If so, check out the following guide: Generating a Batch: CMS-1500s
📘 Continue learning the insurance billing workflow in Start Billing 5 - EDI Files for Claim Submission.