Phase 3 will cover How to submit and track test claims and go over moving into Production Mode to allow your claims to go out live to your payers. In addition, we will discuss claim follow-up best practices and verify the status live claims and walk through correcting any rejections using Claim Tracking.
The Training for this phase is divided into two training sessions to spend more time in the Claim Section giving the Trainee more exposure and time to ask questions.
In Phase 3.1 we will check agreement status’ and validate that your account is on track with Clearinghouse payer agreement set up for all payers added after Phases 1 & 2 staying on track with continuing to have all Top Payers set up if applicable for Claims, ERAs and Eligibility (as needed).
The Status Control will be reviewed as a refresher by searching for claims and feature functionality. We will then transition over to the Claim Tracker where we will learn how to track claims in Test, review the test results, correct claims, resubmit claims and mark Errors Fixed. After reviewing the claim notification results the account can then move from Test to Production Mode where the claims will be allowed to leave and the account will be live (If Applicable).
In Phase 3.2 we will be available for any questions including payer agreements and their status. At this time we will again through the same features reviewed in Phase 3.1 assisting the user in grasping the Status Control to search for claims in Send to Insurance and submit as a batch using the Real-Team Claim Submission in Production Mode. We will review how to Review Claims/Scrubbing.
In Phase 3.2 we will again walk through and do refreshers in the Status Control, Claim Tracker, recapping how to read claim tracking results, correcting, resubmitting and marking errors as fixed. In addition, we will then review the Follow-up Management feature that helps you to focus on priority follow-ups, based on the line item status of outstanding claims. We will also discuss how to generate actionable tasks, follow-up productivity, check claim status’ and the easy to use follow-up screen where all pertinent claim, patient, payer and practice information can be utilized with contacting the payer all on one screen.
This phase will give the user all the tools they need to send, monitor and follow-up on claims assisting in maintaining a low A/R.
Understand Look-up Payer Agreements in CollaborateMD and Connect Center
Document Storage (If Applicable)
Create and Manage Patients
Able to add new patients
Understand Insurance Information, adding of copays to
Understand How to check eligibility
Understand How to print patient Ledger & Statement
Understand Billing Info & Claim defaults
Understand Print & Patient Merge Options
Understand More Options
Perform batch level items
Interface Tracking for interface claims
Status Control for interface claims
Batch Print Claims
Batch Eligibility
Add and Manage Claims
Understand Claim Settings and enabling of RTCS
Understand Enabling of Unapplied Copays when claims entered
Understand invoicing by Rendering Provider Name
Understand COPAY field when associated with the Unapplied Copay and functions
Understand Charges and Other field for NDC and CLIA numbers
Understand benefits of fee schedule
Understand Claim Summary vs. Activity, benefits of Alerts
Understand Print Options, Show Preview
Understand More Options
Understand How Claims Scrubbing/Review works (if applicable)
Understand Batch Print Claims
Understand to submit Test Claims
Managing claims using Status Control
Understand how to locate/review and submit interface claims
Understand claims in a batch for test
Understand Waiting for Review/Incomplete claims and save filters
Understand Right click capabilities: Show Details or Open Claim/Patient
Understand Submitting claims (Default billing status for payer/code)
Create and manage appointments (if applicable)
Configuration requirements: Resources, Appt Types, and Custom Status & Settings
Create and modify appointments
Create and Manage Block Schedule
Understanding searching for appointments
Understand benefit of Appointment Reminders
Payer Agreement
Understanding New Agreement
Understanding Search Existing Agreement - Status
Status Control
Understanding Filters
Understanding Search Claims
Understanding Review Claims
Understanding Interface Claims (If Applicable)
Understanding Update Status and submit batch of Live Claims
Understanding RTCS Results
Claim Tracker
Understanding Track Live Claims
Able identify and review clearinghouse and payer acceptance and rejected claims
Able to Create Filters (Yesterday, Last 7 days, & Last 30 days) search claims
Understanding and Read results - example Correcting, resubmitting and marking as Error Fixed
Understanding Right-click capabilities: Open Claim etc
Understanding and able to view Reports (Clearinghouse & Payer Generated), proof of timely filing (CA, SR, SB and SE files)
Follow-up Management
Understanding Filters
Able to search claims submitted
Understanding batch options, adding notes, set follow-up, claim status
Understanding follow-up screen, reference information, contact payer info, benefits of using Expected Payment info
Understanding how to add Follow-up Note
Action 1. Submit live claims in a batch using Status Control
Action 2. Learn how to print paper claims using Claim Batch Print
Action 3. Monitor the success of LIVE claims using Claim Tracker
Action 4. Understand how to address claim rejections & denials using Claim Tracker Descriptions & Icons
Action 5. Define Claim Follow-Up workflow
Action 6. Learn How to troubleshoot rejected claims video
Action 7. Learn How to resubmit rejected claims video
Action 8. Monitor your Patients, Appointments or Claims using Interface Tracker if using a CMD Interface.
In order to successfully complete Phase 3 of your training and move into Phase 4, you must complete all of your assignments indicated above. During Phase 3, you will learn how to configure and ensure the success of your claims using Claim Tracker and define best practices the benefit your practice or organization. I will conduct a follow-up call to help you monitor the success of your claims, define best practices and help you determine how you will train your staff