5.3 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. The best option for managing & refiling multiple claims in bulk is through the Claim Management page. For the purpose of this section, we will focus on refiling claims from Claims Management.

Go To: BILLING > FINANCIAL > CLAIM MANAGEMENT

REFILING A CLAIM(S):

1. Click on the check boxes to select individual claims, or click on the check box in the top header to 'Select All'
2. Click the Refile tab (bottom page)
3. Claims will be placed in 'Refile' status & will appear in the Print/Send Claims page.

To Edit A Claim(s) Before Refiling:

1. Enter Charges: Go to the 'Enter Charges' page to make any necessary edits.
2. Search the patient & under the 'Encounter Date' select dropdown you can choose the DOS/Encounter you'd like to edit.
3. You can edit ICD & CPT Codes, as well as add/edit modifiers.
4. Click Save Changes if you are applying any changes on the Enter Charges page.

To Make Edits/Changes To HCFA Claim Form Boxes:

1. HCFA Claim: Click on the HCFA Claim tab (top left) & this will allow you to make edits to specific HCFA Claim Boxes
2. Encounter Date: Select from the dropdown the desired DOS/Encounter date.
3. Enter the desired changes to any of the available fields.
4. By clicking Save (bottom page) it will apply changes to the individual DOS/Encounter selected.
   1. Click on Update All if you would like to apply changes to all claims for that patient.

The 'Update All' option will only apply changes to claims with a status of 'Refile', 'New Claim', or 'Pending'. This 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.