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The New Claims option in the Claim Manager is used to create insurance claims in bulk. The basic parameters to see a potential new claim include:
Charges in the patient ledger do not have a claim tied to them already
The patient has active insurance coverage with an effective coverage start/end date that includes the date of service for the charges in the ledger.
Many of the elements in the New Claims Manager are also used in the Outstanding and Paid/Closed Claim Managers. We'll review these elements here.
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The Days Until Overdue column will reflect how close the procedure date of the selected claim is to the timely filing limit. This limit is defined by what is set in the Timely Filing Limit field in References - Insurance Companies > Claims tab.
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Claims highlighted in pink are within X number of days of the timely filing limit, as defined in the Preferences - Insurance > Other Tab > Alert For Upcoming Timely Filing Limits.
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The Outstanding Claims manager is structured similarly to the New Claims manager. The filters work identically to the New Claims Manager Filters. The date range will instead search for the posted date of any claims without a status of Paid/Closed.
In the results section, you can select a particular claim to view what procedures, diagnosis codes, fees, and so on have been submitted. You can reprint any of these claims by checking the box in the Print column and clicking the Reprint Selected button. The claim will not appear twice on a patient's ledger - this will only print another copy of the existing claim, and will only work for paper claims.
Click the Go to Patient button to navigate to the patient's account.
Click the View In Ledger button to go to the patient's ledger and highlight the selected claim.
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The provider must participate with the insurance company.
Either Insurance Estimating must be set up up OR
Allowed Amounts must be set up for the Insurance Company.You must check "Enable Insurance Appeal" in Preferences.
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If Insurance Estimating is set up with Allowed Amounts saved to the plan, MacPractice will automatically warn a user to appeal a charge. More information on configuring Insurance Estimation can be found in the Insurance Estimating documentation.
Setting up Allowed Amounts Without Estimating
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With the Plan Name created and selected, add procedure codes to the Procedures tab. For the first time setting up allowed amounts click the Add From Fee Schedule button, which will bring up a window of existing fee schedules to select from. Select the fee schedule, click the OK button, and all the codes in the selected fee schedule will be added to the plan. After adding the codes, manually select each one and change the fee amount to the allowed amount. Allowed amounts are established between the insurance company and your office; questions about allowed amounts should be directed towards that insurance company.
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There is no Database Utility that will enter all the allowed amounts automatically - each insurance company has different requirements for different codes. However, allowed amounts can be copied into other insurance plans (either under the same company or in another insurance company) by going to your Updated Procedures drop down menu and selecting Copy to Other Plan. This feature allows for minor adjustments to be made to existing allowed amounts rather than starting from scratch.
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