...
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.
...
The area on the bottom right will display the status updates and history for the selected claim, with the most recent information listed first (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.
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.
...
The item that is causing the claim to be invalid will be indicated in red text within the eClaim Status Panel. The missing item will also be indicated in red text within the Claim Details Panel.
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.
...
Whenever an eClaim is rebuilt from any other bin, and when the claim passes MacPractice validation, the claim will move to the Ready Bin.
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.
You can check what our integrated Clearinghouses support in the Clearinghouses section of this article here: https://macpractice.atlassian.net/wiki/spaces/MPHelpDesk/pages/74645542/eClaims+Ability#Clearinghouses-that-integrate-with-MacPractice
...
| Info |
|---|
If the clearinghouse is an integrated Clearinghouse that supports receiving reports, claims will automatically move from the Sent Bin to either the Accepted or Rejected Bin, once reports have come back from the clearinghouse indicating the clearinghouse status of each claim. For these integrated clearinghouse claims, If claims remain in the Sent Bin for more than 24 hours, try to manually receive reports. If new reports do not move claims from the Sent Bin, try receiving reports the next day. The claims are likely still new, and they haven't fully processed yet at the clearinghouse. If 48 hours have passed without your claim status updating after you receive reports, please contact our EDI support team. |
| Note |
|---|
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.
...
If the office does not use MacPractice's partner clearinghouse, Change Healthcare, claims will never move automatically. It is recommended that users manually move claims to the appropriate bin, based on whichever method claim statuses are communicated by the non-partner clearinghouse.
When a claim is sent through MacPractice's partner clearinghouse, and the claim has been rejected, either by the clearinghouse or the payer, the rejection message will appear in the eClaim Status Panel in red text.
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.
It is possible for a payer to reject a claim that has been accepted and sent along by the clearinghouse. If an eClaim is accepted by the clearinghouse, it will move to the Accepted Bin. If a subsequent report comes in for that same claim from the payer that indicates a rejection, the claim will then move to the Rejected Bin.
A status of "Accepted" from the clearinghouse does not automatically guarantee that the claim will be accepted at the payer. A status of "Accepted" from the payer does not mean that the payer is guaranteed to pay on the claim. The "Accepted" status only means that the claim met all technical criteria to be processed at the current entity and sent on in the next stage of processing.
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.
...
When all charges on an eClaim have had payment applied to them, including any 0.00 payments, the claim will move to the Paid/Closed Bin. If any procedures on a claim are left unpaid, the claim will not move to Paid/Closed.
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.
...
Claims that are in the Archived Bin will not be parsed when entering the eClaims Ability. They will only be parsed when the Archived Tab is selected within the eClaims Ability. Claims in all other bins will be parsed upon entering the eClaims Ability.
The parsing of claims doesn't take much time when there are only a few unarchived eClaims. However, the claims can gather quickly in other bins. The more claims that are parsed when entering the eClaims Ability, the longer it will take for the ability to load.
The only way that eClaims can be moved to the Archived Bin is by user interaction. The claims can be moved, either by using the "Move To" pop-up at the top of the eClaims Window, or by selecting the claim in the patient's ledger and using the "Other" pop-up menu.
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.
...
There are occasions in which the Rebuild button won't update new information. For further details on when not to use the Rebuild button, click here.
...
Claims will be assigned a status when they are initially created. The initial claim status will either be Invalid or Ready. Ready claims are claims that pass MacPractice validation and are ready to be set to the clearinghouse for transmission. Invalid claims have failed MacPractice validation and need to be reviewed before they can be sent. To review an invalid claim, select it in the eClaims ability. The pane in the bottom right hand corner will show you details about why the claim is invalid.
...