eClaims - Creating an Electronic Claim

Creating electronic claims generally follows the same process as creating paper claims in the ledger or in the New Claims Manager, except instead of printing the claim on one of the paper forms, an eClaims template will need to be selected at the time of claim creation. To create claims in the ledger, select a charge or series of charges, go to the Print menu and select Create Insurance Claim.

Keep in mind that a paper claim will not necessarily reflect the information that will appear on an eClaim. Many payers have very different requirements for eClaims than they do for paper claims. Printing out a paper claim to verify information regarding an eClaim will not be helpful, because the information won't always match between the two media.

In the claim creation window, change the Form/Template pop-up menu to the eClaims template.

If you need any additional assistance creating claims in the ledger, please click here. If you would like to use the New Claims Manager to print your claims in bulk, please review the Claim Manager documentation here.

You should also set your default eClaims template in the Preferences window if you have not already done so. Go to the MacPractice menu and select Preferences. Select Forms in the sidebar, and in the Default eClaim Template pop up menu, select your template.

Many places of business operate as more than one billing entity, referred to as “Offices” in MacPractice. Usually each office requires its own eClaims template. If this is the case, we recommend that a default template be set within each office reference.

When a default template is set in the office reference, the template set in the office reference will override whichever template is set in the Forms Preferences. With this set, the claim creation window will default to the eClaim template that is set in the office reference associated to the procedures on the claim.

You may also decide to default your insurance companies to select electronic claims for you automatically. This is controlled by your Insurance Company reference, by setting the eClaims Template and Default Forms pop up menus near the bottom right corner.

This setting will override whatever is set in the office reference. If the place of business has more than one billing entity, it is recommended that the insurance reference default eClaim template be ‘None’.

If both of these pop-up menus are set to ‘None’, the payer will default to the eClaims template set in the office reference. If there is no default eClaim template set in the office reference, the payer will default to the default claim form in Preferences > Forms.

If you would like this payer to always be sent on paper claims, you may set the Default Form to your paper claim form, leave the eClaims Template set to ‘None’, and the insurance company will use the paper form by default. If the eClaims Template on the Insurance Company is set, this will override the Default Form and the insurance will default to the eClaim.

There are several Database Utilities that will allow you to set the form or template status for all insurance companies as a whole. Note that Database Utilities can only be performed on the server computer. Please review the Database Utilities documentation for more information.

Once you have created your eClaim, it will be given an initial status of either "Ready" or "Invalid."

You can view the status in the Ledger in the Status column.

The status will automatically update as you work with claims in the eClaims ability and post payments to claims. You may double click on an eClaim in the ledger to go directly to that claim in the eClaims ability for review. You may also manually change the status of an eClaim in the ledger by selecting it, then going to the Other menu and selecting "Set Claim Status _____." Please use this ability with caution, as the status in the ledger is the same status in the eClaims ability, and changing the status incorrectly may prevent the claim from being sent or processed.

The status of an eClaim can be changed in the ledger, from the "Other" menu. There, a new status may be selected. Changing the status in the ledger will move the claim within the eClaims ability. Please use caution when changing an eClaim's status, as moving an unsent claim to the wrong status may prevent the claim from being paid.