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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.
Your claims will be listed under the tab corresponding to the appropriate status. We refer to this section as the Claims table. (A).
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When you have a claim selected in the Claims Table, the area near the bottom left will display the claim details, listing all information on the eClaim. This is the Claims Details Panel. (B). Panel.
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.
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If no claim is selected, the Details Panel and the
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Status Panel
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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 no claims are selected, no eClaim information can be viewed in the Claim Details Panel or in the eClaim Status Panel. With no claims selected, there is no option to rebuild or manually move claims.
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 pressedwill be blank.
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.
Claim Details Panel
When a single eClaim is selected in the eClaims Table, the lower, left panel will populate with a list of claim details and fields. If the user clicks the drop down triangle, it will display a list of fields and values. The values as they are shown within the node are all values that could potentially be written to the eClaim file.
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Not all values that are shown in the claim details will necessarily show on the actual claim. Many values are only written to the eClaim file under specific circumstances. However, if the specific conditions are met, the value that shows in the claim details is the value that will appear on the claim.
For example: If 'Secondary Medicare Type', in the Primary Node is set to "Other Liability Insurance is Primary", this will only populate information in the claim file if the claim is a secondary eClaim that is going to Medicare. If the claim is a secondary claim that is going to Medicare, then the code, "47" will populate the claim, which is the numerical code for "Other Liability Insurance is Primary". If the claim is primary, or if the claim is going to a payer that is not Medicare, this information will not populate the claim file at all.
Claim Status Panel
Once an eClaim has been created, every activity that occurs with that eClaim is updated in the eClaim Status Panel. This is the lower, right panel within the main eClaims window. Each status will reflect the date and time of the activity, which user performed the activity, and which activity was actually performed.
Trace Numbers (CHC Only)
In the case of automated clearinghouse response, a trace number will be provided, as well as an accepted or rejected message. Automated clearinghouse responses are only provided by MacPractice's partner clearinghouse, Change Healthcare.
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Trace numbers will not be provided on Inovalon or DentalXChange-submitted claims at this time (Last updated 7/18/24) Furthermore, as of the time of this note, we are awaiting confirmation that trace numbers will be available on the new Change Healthcare platform. We will update this article when this is confirmed. |
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A trace number is an identifier that is assigned to each, individual claim when it is processed at the clearinghouse. When a trace number is listed within the eClaim Status Panel, the user can click on the trace number to send in a trouble ticket to MacPractice. If a user has a question about a claim, once the trace number is clicked, a window will appear. A classification must be selected, to indicate whether the ticket is in regards to a question or a problem. An email address must also be provided.
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.
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