Permissions: You must have Billing Permissions with the ability to "Submit Claims to Clearinghouse" enabled.
The process for sending Electronic Claims follows the same workflow in TheraNest for all Clearinghouses.
In order to Submit Electronic Claims, ensure the following:
- Must be connected to a Clearinghouse.
- Your Client's Insurance Billing Information is setup.
- The Client must have a Diagnosis in the Initial Assessment & Diagnostic tab. If multiple Cases exist for this Client ensure the Claim is linked to the correct Case.
- An Invoice is created for the Appointment. You can only generate Claims from Invoices.
There are three steps to Submit Electronic Claim:
- Create the Invoice.
- Add the Invoice to Awaiting Submission - The Invoice becomes a Claim and sits in the Awaiting Submission queue.
- While you Claims are Awaiting Submission, you can perform a general Claim scrub. Claims can be checked for common errors such as Date of Birth, Gender, Address, Diagnostic Code, etc. If a Claim has no errors can be submitted to the Clearinghouse.
- Submit Claim to Clearinghouse All Submitted Claims are sent to the Clearinghouse at the end of each business day.
Add Claim to Claims Awaiting Submission
You can add the claims to awaiting submission in multiple ways. You can either add it when you are creating the invoice, add it from the clients ledger, or add multiple claims to awaiting submission using Batch Processing.
Add a Claim to Awaiting Submission from a new Invoice
- Create and complete the invoice.
- Click Save, select Add to Claims Awaiting Submission.
Add a Claim to Awaiting Submission from the Ledger
- Locate Invoice on the Client Ledger.
- Click Actions button and select Add to Claims Awaiting Submission.
Add Multiple Claims to Awaiting Submission Using Bach Processing
- Click Billing from the Primary Navigation Bar.
- Select Batch Invoicing from the left menu.
- Navigate to Process Existing Invoices.
- Select the filters you wish to find invoices to add to Awaiting Submission. Click Search
- Select the claims you wish to add + click "Add to Awaiting Submission"
Check Claims for Errors & Submit Claim
Checking for errors in TheraNest is a simple scrub that checks for missing items such as address, birthdate, Provider, etc. It will not validate that information entered is correct, it is simply searching for missing information.
- Click Billing tab in primary navigation bar. Claims > Awaiting Submission tab displays.
- Select checkboxes for Claims you wish to check.
- Click Check Select Claims for Errors button above.
- Fix prompted errors.
- Select appropriate Claims and click Submit Select Claims button.
Claims will now display in the Submitted tab. All Submitted Claims are sent to the Clearinghouse each business day at 4:30p CST.