Once you have created an Invoice in TheraNest you can instantly submit them to the Clearinghouse.
Once the Clearinghouse receives your Claims, they are scrubbed for errors at the clearinghouse level.
A general check for errors can be done before your Claim leaves the system. However, your Clearinghouse can check for errors that are specific to your Payers.
If your Claim has been rejected at the Clearinghouse, it will not be forwarded to the Payer.
IMPORTANT: TheraNest is not able to see if your Claims have been rejected, so it is essential to check on the status of your Claims with the Clearinghouse.
Life Cycle of a Rejected Claim. See Info Below on How to Resolve
If your Claim has been rejected, it will need to be corrected and resubmitted.
If you are having trouble correcting your Claims we are happy to help you troubleshoot the problem.
If your claim is "clean" free from errors, it will be sent to the Payer.
Some Payers require you to complete EDI enrollment paperwork before they forward your Claims electronically.
Be sure to check with your Clearinghouse to see if EDI Enrollment is required by any of the Payers you work with.
Life Cycle of a Successful Claim. See Below for How to Process Successful Claims
Once your Claim is received, the Payer will process it.
If your Claim is denied, the Payer will notify you either by a paper explanation of benefits (EOB) or electronic remittance advice (ERA)
Depending on the denial reason you can correct and resubmit the claims, or appeal. In some cases a denial is expected, such as for a non- covered service.
If your Claim is paid, the Payer will send you notification of this either by EOB or ERA. They will pay you either by paper check or EFT, depending on what your agreement is with that Payer.
IMPORTANT: TheraNest will only be able to display/process the ERA's that are available on your clearinghouse's server. Check with your clearinghouse to see if they can receive ERA's from your payers, or if you have any missing ERAs.
Once you are receiving ERA's in TheraNest, you post them to your Client's Ledger by following the tutorial above.
Check out our Billing E-Book below to learn more about the Billing Process.