RXNT automatically advances the responsible party and generates a claim to the secondary or tertiary payer when you Save & Post an insurance payment. The claim will either be transmitted electronically or dropped to payer based on the claim filing method selected for the payer within your account.
Determining the Responsible Party
To determine the responsible party, RXNT first looks at all of the cases linked to a patient. The cases associated with the patient will determine if the requeue box is selected within the patient grid of the insurance payment.
The requeue box is selected only when all of the following are true:
- The patient has at least one case with a secondary payer
- The patient's case containing a secondary payer is associated with at least one encounter that does not have the status of Settled
- The ERA does not indicate that the previous responsible party forwarded the claim to the secondary or tertiary payer
When Save & Post is clicked and the requeue box is selected for a patient, the system checks if the associated encounters have a secondary or tertiary payer. If the associated encounters have a secondary or tertiary payer, then the system will generate the corresponding claims automatically. If no secondary or tertiary payer exists for the encounter, the system will advance the responsibility to the patient.
ERAs & Advancing Claims
When the payment is received via an ERA, RXNT automatically links the encounter(s) associated with the specific payment. This allows the requeue selection to be specific to the cases for the linked encounters, meaning that the requeue box will only be selected if an encounter linked to the payment has a secondary or tertiary insurance.
Choosing to deselect the Requeue box will impact all encounters for the corresponding patient, stopping the automatic claim submission for each linked patient encounter. While no claims will be sent, the responsible party will still advance.
In the event that the secondary payer is billed first, the system will create a claim for the primary payer associated with the case. If there is no primary payer associated with the case, the system will advance the responsible party to the tertiary payer and queue up the claim accordingly.
Requeueing denied claims
When posting a payment for a rebilled claim (meaning that the claim was initially denied and then rebilled to the same payer), please follow the steps below:
- Ensure that you deselect the Leave Open checkbox for the line item that was rebilled if you agree with the payment received.
- If the encounter case has a secondary or tertiary payer and the Requeue box is deselected, please select the Requeue checkbox to automatically create and send a claim to the secondary or tertiary payer.