Permissions: You must have Billing Permissions with the ability to "Submit Claims to Clearinghouse" enabled.
While you can submit Claims to a non-Apex Clearinghouse, the information available within TheraNest after you've submitted the Claim will be limited.
Submit Claim with a Non-Apex Clearinghouse
- 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 reside on the Submitted tab and are sent to the Clearinghouse each business day at 4:30p CST.
- Check Claim Status - You will need to check in with the Clearinghouse to see if the Claim was Accepted or Rejected.
IMPORTANT: TheraNest is NOT able to see the status of your Claim , it is essential that you check on the Status of your Claims with the Clearinghouse.
- Claim is Accepted & Sent to the Payer.
- Payer Approves or Denies Claim.
- If Approved - The Payer will process for Payment if applicable. You will receive either EFT or paper check Payment and an ERA or EOB.
- If Denied - You will need to make corrections in TheraNest and resubmit if applicable.
If your Claim is rejected it will not be forwarded to the Payer. The process will stop. It is important that you check the Status of the Claim and then take necessary actions to correct and resubmit.
- Make necessary corrections in TheraNest and resubmit if applicable.