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Description

Following up on claims is an important weekly task. The Insurance Outstanding report will help you find Unpaid , Partially Paid and Unbilled claims.

Note that Unbilled Claims are identified as any claims (on an insured account) that have not been sent to EDI. This report option is not sensitive to manually printed claims.

To avoid confusion, we recommend editing claims printed manually and setting the status to P, “printed”, so your team can quickly identify the claim’s status and move on to the next name on the list.

Selections Available:

Unpaid Claims, Billed Before… : Use this option to find outstanding claims. Keep in mind that claims sent less than a week ago are not likely to have recieved payment yet.

Claims Partially Paid: Generate a list of claims not paid in full. A great tool for following up on dual insurance claims. If the primary insurer has sent payment, the secondary can be manually billed for the remainder of the claim.

Unbilled Claims: Show any patients with insurance on file who’s claims have not been billed to EDI.

The 3 available options will all print with totals included; examples of these reports are abbreviated above.

Claim Total: Shows you the total billed for that claim, Patient and Insurance owing.

Ins. Estimate: The original charge when posting treatment. If this number is 0 but there is a balance, the original splits were different, and a transfer balance adjustment was used.

Ins. Balance: The remaining Insurance owing for the claim.

To maximize the accuracy and utility of this report, be sure to adjust the claim balance after receiving an E.O.B. (Explanation of Benefits) from the carrier. This makes entering payments much easier.

i.e. if the insurance EOB states they will pay $250 toward the claim, perform a Transfer Balance adjustment to move the right portion from the patient to the insurance balance.

The Unbilled Claims report only recognizes EDI submissions. This means if someone printed a manual claim and sent it in, that claim will still be listed on this report. To avoid duplicate submissions, be sure to set the claim status manually after printing for manual submission. See the image below for details.

To do so, right click the treatment in the Treatment or Planned/Incomplete box at the bottom of the claim entry page and choose “Edit Treats”. Look to the center of the popup box and find the “Sts” drop down menu. In here, you can set a specific claim status to reflect your actions taken and keep your team informed. This will be extremely useful when dealing with Partially paid claims.

These reports will only present patients who have an insurance policy on file. You will not see claims for patients who have no insurance coverage. You can find those outstanding balances in an A/R report, like the A/R Manager.