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Before you can send eClaims
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The eClaims ability in MacPractice allows you to send, track and manage electronic claims.
Before you can send electronic claims, you will need to begin the enrollment process with one of our clearinghouses. Please contact the MacPractice Enrollment department at 877-220-8418 if you have not enrolled for eClaims. After your enrollment, you will receive an eClaims training, during which the eClaims trainer will install and set up your eClaims template.
Clearinghouses that integrate with MacPractice
The following clearinghouses integrate with MacPractice:
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Before training, MacPractice recommends that you familiarize yourself with the MacPractice Ledger, and make sure you know how to enter procedures, post payments and create paper claims. Please review the Ledger documentation if you need assistance with this process.
eClaims Ability Overview
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The eClaims ability is divided up into 3 panes. The area along the top contains 7 different tabs listing different claim statuses.
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The area on the bottom right will display the status updates and history for the selected claim, with the most recent information listed first. We refer to this as the Claim Status Panel. (C). You will utilize this area to review problems with invalid and rejected claims, and can also use this information to see exactly when claims were sent, received, and so on.
Claim Details Panel and the Claim Status Panel
When a single claim is selected, the specifics of the claim can be viewed in the Claim Details Panel. The history of the selected claim can be viewed in the Claim Status Panel. A single claim can also be rebuilt or manually moved. When more than a single claim is selected, no information will appear in the Claim Details Panel or in the Claim Status Panel.
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If the Send button is pressed from the Ready Bin, with no eClaims selected, all claims that are viewable in the Ready Bin will be generated into a .CLM file, also known as a Claim File or a Batch File. A .CLM file contains all individual claims, gathered into a single batch. If the template is for a partner clearinghouse, the eClaims will also be transmitted to the clearinghouse when the Send button is pressed.
eClaims Tabs / Bins
Let’s break down each of the Bins in eClaims. These are sorted into tabs in the eClaims ability, and they relate directly with the different Claim Statuses.
Invalid Tab
Regardless of what clearinghouse an office uses, MacPractice will validate all eClaims that are created within the software. All electronic claims are expected to have certain information, regardless of what the claim's intended destination or clearinghouse. If expected information is missing from an eClaim, MacPractice will move the claim to the Invalid Bin. Any claims that are moved to this bin automatically by MacPractice will be displayed in red text.
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Whenever an eClaim is rebuilt from within any other bin, and if the claim is missing required information, it will move to the Invalid Bin. If missing information is causing a claim to move to Invalid, and the user adds that information to where it is missing within MacPractice, the claim will move from Invalid to Ready when the claim is rebuilt.
Ready Tab
When an eClaim is successfully created, it will go to the Ready Bin. These claims have passed all of the MacPractice validations and are ready to be sent.
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The Send Button is only usable from the Ready Bin. When the active bin is any other than Ready, the Send Button will be grayed out.
Sent Tab
Once claims have been successfully transmitted to a clearinghouse, or the .CLM file has been generated, all claims that were selected to be sent will move to the Sent Bin. What happens to these claims depends on whether the clearinghouse these claims have been sent to supports receiving eClaim reports in MacPractice or not.
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If the clearinghouse does not support receiving reports in MacPractice, the Sent Bin will be the final location of these claims until you manually adjust their claim status. You’ll need to consult that clearinghouse’s electronic portal to get information on these claims after being sent. |
Rejected Tab
When receiving reports from MacPractice's partner clearinghouse, any claims that have been rejected by the clearinghouse or by the payer will be moved to this bin automatically.
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Occasionally a claim may reject at the clearinghouse or payer, and then later may be reprocessed. It is possible at that time for this same claim to be accepted. A report will come back from the payer or the clearinghouse that indicates the claim has now been accepted. However, no claims will ever automatically move from Rejected to Accepted. If a claim is ever rejected, then later accepted, it will need to be manually moved by the user to the Accepted Bin.
Accepted Tab
Claims that have not been rejected by the clearinghouse or the payer will move automatically to the Accepted Bin, once the associated report is downloaded. This will only occur for claims sent through the MacPractice partner clearinghouse, Change Healthcare.
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If a claim has been in the Accepted Bin for more than ten business days, and no payment has been received for the claim, it is important that the office call the payer to follow up on the claim. MacPractice cannot research a claim that has been sent more than 30 days ago, so it is important that any problem claims be addressed as soon as possible.
Paid/Closed Tab
eClaims move to the Paid/Closed Bin only as a result of user action. Reports do not affect the movement of claims to this bin.
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Any method of registering payment in MacPractice will affect the movement of eClaims to the Paid/Closed Bin. If an ERA is posted, and it contains payment amounts (including 0.00 payment amounts) for every procedure on an eClaim, the claim will move to Paid/Closed. If all procedures on an eClaim are paid through the Bulk Insurance Payments Manager, the claim will be moved to Paid/Closed. Also, if all charges on an eClaim are paid by manually posting an insurance payment in the Ledger of a patient record, the claim will automatically be moved to Paid/Closed.
Archived Tab
aims have been moved to the Paid/Closed Bin, they begin to pile up. It is recommended that claims not be left to sit in this bin for too long. It is a good idea to move claims that are over a few months old to Archived.
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In order to unarchive an eClaim, the user simply needs to either manually move the claim from the Archived bin or rebuild the eClaim. The former method will move the claim to whatever bin the user wishes. The latter method will either move the claim to Ready or Invalid, depending on whether the eClaim passes MacPractice validations or not.
As you work with eClaims
As you work with your electronic claims, they will be moved from tab to tab in the eClaims ability as their status changes. Each tab will also display the number of claims within the tab next to the name. If you do not see a number, it simply means MacPractice is currently loading that information. If you are in Many mode (that is, you don't have a patient selected), you will see all patients' claims of a given status within the tab.
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If you have a patient selected, you will only see that patient's claims. The number next to the status name will also show you how many claims you are viewing out of the total number of claims in that status. In the example below, we are viewing 2 out of 42 invalid claims. If a bin contains only s claims for other patients than the one that is selected, the bin will appear empty to the viewer. The numbers in the title tab will indicate there are claims in the bin, even if they cannot be viewed.
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Changing eClaim Status
You may manually change the claim status in the eClaims ability by selecting the claim, and using the "Move To" pop-up menu (A). Changing the status in the eClaims ability will also change the status in the patient's ledger as well.
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If you created a claim with the wrong template in error, you will need to create a new claim using the correct template. If the original claim has not been sent, you can delete it; if it has been sent to the clearinghouse, you should close or archive the original claim. |
Selecting a Claim to Edit or Review Details
Select a claim in the upper pane to edit the claim or review the claim details. With a claim selected, the bottom left hand area will show you the current information listed on the claim, including the provider, patient, primary, and procedure information, among others. This area should not generally be used to edit the claim information, because it does not fix the source of the problem. MacPractice recommends making the change in the patient's record, and simply fetching the updated claim information in the eClaim itself by clicking the Rebuild button. Utilizing this method will fix the source of the problem, so that it does not occur again. If you make the change in the claim data in the eClaims ability, it will only temporarily fix the issue on the selected claim. Rebuilding the claim at any point will remove any data you have manually entered into the claim details.
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