RXNT claim scrubbing feature saves you time and helps you get reimbursed quicker. You can quickly set up claims and see all edits at one time. Primary, secondary, or tertiary claims will move automatically to our claim scrubbing queue for additional validation before they go to the clearinghouse and payer. You’ll see the real-time status of your claim and get explicit information about edits and how to correct them.

To minimize claim rejections through the Clearinghouse, RXNT has implemented updated claim scrubbing rules. RXNT's Claim Scrubber will now verify the following:

  • The CPID being used for claims being sent is on the Relay Exchange Payer List.

  • The Payer ID being used for claims being sent is on the Relay Exchange Payer List.

  • If sending a Payer address, the address must not be incomplete. For example, sending a claim with only a street address and no City/State/Zip would cause a rejection with the Clearinghouse, so we've ensured the Claim Scrubber will flag that as well.

Send claims

Single claims Bulk claims

Primary Claim

1. Click on Send Claim/Save Claim on the encounter screen.

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2. The system will move the encounter to the Scrubbing for Errors tab to perform claim scrubbing. A message saying Scrubbing claim is displayed in the message column, indicating that the claim scrubbing is in progress. 

The encounter cannot be accessed from the Scrubbing for Errors tab. As soon as the claim scrubbing is complete, the claim is sent/saved successfully if no claim edits are required.

3. If claim edits are required, the encounter will move to the Corrections Required tab.

4. The Corrections column displays the number of edits that are required for each encounter. Hover over the number to find associated corrections in a tooltip.

Select the Export Corrections button to download a list of the encounters and their associated corrections.

5. Click on the encounter number.

6. The encounter displays each required claim edit.

 

Secondary/Tertiary claims

Automatically generated or manually generated secondary/ tertiary claims will go through our claim-scrubbing queue for additional validations before going to the clearinghouse and payer. 

1. Access an insurance payment from the Insurance Payment tab.

2. Make sure the Requeue box is checked for the patient to automatically generate secondary/tertiary claims.

3. Select the encounter for which a secondary/tertiary claim should be created.

4. Click on Save and Post.

5. The associated encounter will go to the Scrubbing for Errors tab to get converted to a secondary or tertiary claim. As soon as the claim scrubbing is complete and no claim edits are required, the claim is sent successfully. If claim edits are required, the encounter will move to the Corrections Required tab.

The Payer Priority column indicates if the payer is primary/secondary/tertiary.

6. Click on the encounter number in the Corrections Required tab.

7. The encounter displays each required claim edit.

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8. Make the edits and click on Save.

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9. The claim edits will be displayed on the encounter until you Manage Claims and hit the Send Claim or Save Claim button. 

The encounter moves to the Scrubbing for Errors tab and the process is repeated.

Remove encounters

If an encounter is in the Corrections Required tab but does not require further action, you can remove it from the queue by selecting the encounters and clicking Remove Checked. This will  place the encounter in the tab corresponding to its status. 

Claim limits

Some clients have opted for billing subscriptions with claim limits for each provider. When a provider hits the claim limit for the month, the encounter will be added to the Corrections Required tab.

When claim limits are reached, you have two options:

  • Wait until the 1st of the following month to send claims when the provider's claim count resets 
  • Contact Sales at sales@rxnt.com or 1-800-943-7968 and request to upgrade your subscription

Once you have available claims, you can continue billing the encounters from the Corrections Required tab. Once in the Corrections Required tab, you will see two encounter statuses: New Encounter and Sent To Payer.

New Encounter Sent To Payer

1. New Encounters do not have any associated claims. 

2. When you click into the encounter, simply choose to Send Claim or Save Claim. This will remove the encounter from the Corrections Required tab and send the claim. 

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Helpful tips

  1. Encounters with the status "Claim Scrubbing (In Progress)" cannot be edited.
  2. To optimize workflow, clicking Send claim or Save claim will navigate you to the Encounters screen where charges can be easily added.
  3. Clicking Send claim or Save claim from any screen will launch the new claim scrubbing process.
  4. Receiving this error: "Claim scrubbing was not completed for this encounter. Send or save claim again."? This means a system error occurred during the claim scrubbing process. Click Send or Save Claim again.
  5. If the case is changed to Self Pay for any encounter in the Corrections Required tab,  the associated encounter will automatically move to the Billed tab and claim validation messages will be cleared.
  6. When the CHC timeout issues occur (which means CHC did not acknowledge that they received the claim), the encounter will get sent to the Billed tab, and the associated claim will have the status "Errored" with the message "RXNT did not receive confirmation from ChangeHealthcare that this claim was received. Please resubmit this claim."
    If we receive new status from Change Healthcare, the error and the status are removed and updated accordingly.
  7. If you'd like to submit claims that are currently stuck in the Scrubbing for Errors tab due to the Change Healthcare Outage to Relay Exchange:
  • Select the Encounters you'd like to send and select Cancel Send.

  • The selected claims will move to the Claims tab under the To Send Electronic tab, where they can be sent to Relay Exchange. 

 

 

Still, need help? Contact us!

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