Creating HCFA's

 

Creating HCFAs

Before you get started:

• All claims generated, whether they be Paper or Electronic, will be created here.
• It is advised that your Insurance Payers have their printing options and scrubbing requirements set before creating your HCFA claims in Admin > Payers. This prevents claims being sent out with incorrect info, waiting for a denial, fixing requirements, re-billing a claim and resubmitting for payment.
• All patients you would like to create a HCFA for, MUST have insurance info placed into their Patient file and have the correct start date entered.
• All Claims generated will be in the PRINT IMAGE FORMAT.
• If you were billing through a different software and would like to keep the clearing house you were using prior to joining, you MUST make sure your clearing house is aware so they can perform mapping on your claims. This ensures that everything is lining up properly and you do not receive a bunch of denials.
• If you are printing claims, the software does not supply HCFA forms. You would need to purchase blank forms for the data to be printed on.
• If this is the first time generating claims and you have recently signed up with Office Ally or another clearing house of your choosing, they will require a minimum of 5 test claims to be generated so, they can perform the necessary Mapping to ensure all data lines up properly. Once your claims are created, you will contact your clearing house so, they can show you how to upload the saved claims to their software. (If you are using actual HCFA's that need to be sent for payment, please let them know they are not just test claims)

Let’s Generate some Claims!

Under Billing

Create HCFAs

You will be provided several filters to select when generating your HCFA claims:

• Date Of Service: You can leave the setting Defaulted to All Unbilled Charges or select a specific date range.
• Clinics: You can leave the default to All Clinics or Select a specific Clinic, if you have several in your Software.
• Providers: You can leave the default selected to ALL Providers or generate claims for a specific provider in your clinic.

• Patients: You will see the“All Patients” button selected because it will default to run for ALL patients with unbilled charges but, you can select the “Select an Individual Patient” option and press the “Select” box and find an individual patient you would like to generate a claim for.
• Payer Level:You can create claims for Primary, Secondary or Tertiary payers. If you select Secondary or Tertiary from the dropdown, you will need to select “Only unbilled charges with a balance” or “All Unbilled Charges.”
• Additional Filters: You can select “Automatically put dates of service from different years onto Separate HCFAs”, “Flag Claims that have a total charge amount over___” and “Do NOT sort charges by Amount” (This will place charges based on how they were entered into the Patients appointment)

Your software will default to “Combine Multiple dates of service on one HCFA form” but, you can select “Create a Separate HCFA for each date of service”.

Please keep in mind: You can separate dates of services but, cannot separate charges in a date of service.

• Payers: the software will default to have all payers that are selected to run on the 02/12 form but, you can uncheck the box that states, “All payers for current HCFA type” and create HCFAs for a certain payer.
• Case Classification: Again it is defaulted to run for ALL Case Classifications. If you would like to run only certain types of cases, select the appropriate ones. You can select multiple by holding down the CTRL button.

Please Keep in mind: Its not always best to get very detailed with the filters being selected. Patients can have incorrect info in their file and may not generate if you are getting specific with your filters.

For Example:

A patient can be tied to a Cash case when it should have been General Insurance. So, when you are selecting to run just General Insurance, a patient that should be included will not be.

Once you have everything set properly, Select Next Button.

When you select Next, you will see All of your claims that Generated.

You will check to make sure they are set to generate the appropriate way.

• Output option: Each claim will have Paper or Electronic selected. This is coming from your payer’s printing options. You can manually change from Paper to Electronic and vice versa on this screen but, It is recommended that you go to Admin > Payers > Select Payer > Edit > Go to Printing Options tab and Change out put option to correct type. This way you do not have to manually change it each time.

• View Claims: You can View a Claim by clicking on the View Box and Selecting View at the bottom right of the screen.

• Scrubbing: If you see a number at the bottom left of the screen, this tells you how many failed claims. These will not generate until corrected. To see the details, Select “Print Report”. To help in guiding how some of these are fixed, visit our Scrubbing Report Errors Article.

Scrubbing Report:

The Scrubbing Report displays the Patient’s Name, Case and Payer they have selected in their patient file.

It will display all the reasons why a claim was not generated and show the location within brackets [...] of where you need to go to correct the issue.

If there is a date present to the far right, that indicates what appointment you must review.

You can print this report, so you do not have to go in and out to gather the info needed.

Once your scrubbing issues have been resolved, Select the Back button at the bottom Right of the main screen.

Select Next on the Create HCFA screen, for the system to grab the new data.

Please Keep in Mind: You do not have to correct scrubbing right away to generate the claims that did generate. If you would like to create the current claims and work on the scrubbing issues later, you are more then welcome to do that. Just select Next. Any claims that fail scrubbing will remain until corrected..

Once all claims appear, Select Next.

If you had any claims set to PRINT, you will see a print window generate.

• Make sure the correct printer is selected.
• Please add your HCFA forms to your printer and select print for data to be printed on top of the claim.
• Print

If you are generating claims ELECTRONICALLY there are some steps that need to take place

A window will generate showing where claims were sent. This is the file you will upload your claims from, to the clearing house.

*If this is the first time generating electronic claims on your specific computer*

Follow these one-time steps:

• You will minimize the software, leaving this window open.
• Click on the file image, circled in this image.
• Drag and drop to desktop.
• Rename file to “Billing” or something similar.
• Add Submitted Claims folder within the billing folder so, all claims that are uploaded to the clearing house can be moved there. This way you always know which claims need to be sent and which ones have already been sent.

After you close the file folder, you will see the report of how many HCFAs were printed in your software, how many images were generated for Electronic Billing and how many failed scrubbing that still need to be corrected.

When finished reviewing Select Finished.

All FINISHED!!

- Support Information -

 If you have any questions or need assistance with this process please contact Support by:

Live chat: Click the 'Support Portal' button in your main toolbar (on left-hand side) within the software, click the green 'Support' box in bottom right of screen. Hours of operation are M-F 8am-6pm CST.

***This has the fastest response time***

Phone/Text: 909-378-9514

Email: [e-mail]