Bill Patient Only or Resubmit Claims

This article provides instructions for managing rejected and denied claims through Manage Claims along with the Bill Patient Only option. The Bill Patient Only option is used if a claim was created in error and should not be billed to the payer. This ensures that the claim is not resubmitted to the payer but is processed internally for patient billing. 

Bill patient only

If a claim has been created for a payer in error, you can bill the patient instead.

Begin by navigating to the Encounter tab located in the top navigation bar.

Select either the Unbilled, Ready to Send, or Billed tab to locate the encounter, then click the Encounter Number

Click Manage Claims

In the Manage Claims screen, check the box for Selfpay

Click on Bill Patient Only.

Click Close

You’ll receive a confirmation pop-up warning that claims for each payer should be resolved in order to bill the patient only. Click Yes to proceed. 

While it’s optional, selecting Bill Patient Only won’t resolve the claim. However, it’s expected that claims be resolved prior to billing the patient to prevent billing discrepancies.

Once you confirm, you will not be able to take any additional action from the Manage Claim screen, which is indicated by the Lock Icon at the top, other than to Revert from Bill Patient Only which reverts the responsibility back to the payer.

Click Close

The system automatically updates the encounter status to Ready to Bill placing the encounter payment amount due in the patient’s responsibility. 

Claim resubmission

Resubmitting a claim after updates is straightforward using the Manage Claims screen. 

Navigate to the Professional Encounter screen. The payer will be indicated as the responsible party. 

Click Manage Claims

Select the Resubmission Code from the dropdown menu in the Manage Claims screen. 

If the payer requires the Original Reference Number, enter it in the Original Ref. No section.

If you want to Suppress previous payment information on claims, choose the option from the drop-down menu. 

Click Send Claim or Send to Optum. To learn more about Sending and Saving claims, click here

The system will then move the encounter to the Scrubbing for Errors tab for claim scrubbing. You’ll notice a message in the Encounter screen indicating that Claim scrubbing is in progress. Once the claim scrubbing is completed without errors, the claim will be sent directly to the payer. 

To save the claim for future submission, click Save Claim

The system will then move the encounter to the Scrubbing for Error tab for claim scrubbing. After the claim has been successfully scrubbed of errors, it will be moved to the Ready to Send section within the Claims tab.

Create a new claim for resubmission 

Creating a new claim for resubmission is a simple process that can be directly done from the manage claims screen.

From the Professional Encounter screen, click Manage Claims.

In the Manage Claims screen, check the box next to the Payer

Click Create Claim.

To deselect a CPT code that doesn’t require resubmission, uncheck the respective CPT code line item.  

Select the Resubmission Code from the dropdown menu in the Manage Claims screen. 

If the payer requires the Original Reference Number, enter it in the Original Ref. No section.

To include Claim Notes, choose the claim note type from the drop-down menu and then input the relevant details in the box on the right side. 

Click Send Claim

The system will then move the encounter to the Scrubbing for Errors tab for claim scrubbing. You’ll notice a message in the Encounter screen indicating that Claim scrubbing is in progress. Once the claim scrubbing is completed without errors, the claim will be sent directly to the payer. 

To save the claim for future submission, click Save Claim.

The system will then move the encounter to the Scrubbing for Error tab for claim scrubbing. After the claim has been successfully scrubbed of errors, it will be moved to the Ready to Send section within the Claims tab.

You’ll receive a confirmation pop-up stating that the claim already exists for the payer. Click Yes to cancel the existing and create a new claim. You’ll be navigated back to the patient dashboard. 

 

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