4.3 Refiling & Editing Claims

Refiling & Editing Claims

Claims can be placed into refile status in a few different ways. The option to refile a claim for a DOS is available in Patient Accounting, on the E-Claim Tracking page & also through the Claim Management page. You can also put the responsibility back to the insurance when posting an EOB/ERA to refile the claim as well. The best option for managing & refiling multiple claims in bulk is through the Claim Management page.

Go To: BILLING > CLAIMS CENTER > CLAIM MANAGEMENT

Selecting 'Refile' does not automatically refile a claim, and when clicking 'Refile' it simply puts a claim(s) into Refile Status & places the claim in the Print/Send Claims to further manage. Nothing gets filed until a user selects an option to file claims on the Print/Send Claims page.

REFILING A CLAIM(S) IN CLAIM MANAGEMENT AND ECLAIM TRACKING:

1. This can be done in bulk by:

   1. Clicking on the patient's you wish to refile

   2. Clicking on the Refile icon at the top of the page

2. On an individual basis

   1. Click on the 3 vertical dots and click refile.

3. This will then ask you if you would like to manage these claims now.

   1. If cancel, you will not leave the page

   2. If Confirm is selected, will take you to print/send claims where only those claims will be showing.

To Edit A Claim(s) Before Refiling:

1. When in Print/Send claims, click on the DOS

2. This will bring up the Enter Charges and HCFA 1500 Pop up

3. You can now make any edits to the CPT, ICD Codes, Modifiers or Any boxes on the HCFA tab

4. Click Save and Approve at the bottom

   1. Click on Apply Changes to all open claims box if you would like to apply changes to all claims for that patient.

The 'Apply Changes to all open claims' option will not apply changes to claims with a 'Filed' status & filed claims can only be edited after they have been placed in Refile status. Also, the HCFA Claim tab does not apply to Self-Pay charges & a DOS/Encounter must be Insured in order for the HCFA Claim tab to apply.

If edits are applied only the the HCFA Claim tab, the related claims will remain in Print/Send Claims & changes will be applied. When changes/edits are applied to the actual charges (ICD/CPT Codes, Modifiers, Changing Insurance) & you click Save Changes, these claims will be marked with a 'New Claim' status. These claims will have to be re-approved and will appear on the Approve Charges page. Once approved, they will once again be sent to Print/Send Claims. All claims can then be previewed in Print/Send Claims & filed the same way you would file new claims.

Changes/Edits To Provider ID's & Insurance Co.'s: Any edits/changes made to the Provider profile in the Admin Account, or on the Insurance Company itself, will automatically be applied to awaiting claims that are in Approve Charges or Print/Send Claims.

To Make Changes to the Patient's information:

• When in Print/Send Claims click on the patient's name

• Go to the desired tab you need to edit and make your edits

• Click Save at bottom after making edits.

This will NOT affect anything under the section Patient Condition Related to. This information must be updated on the HCFA Tab.

To Refile Directly from Eclaim Tracking

1. Click on Patient’s DOS

2. Make any edits to the Enter Charges screen and save

3. Make any edits to the HCFA 1500 tab and save

4. Click save and send. This will automatically refile that claim without having to go to Print/Send Claims