*This is a Premium Add-on feature.

Common Problems with manually checking Claim Status

• Challenge of timely follow-up on Insurance Claims that are delayed or have no response from the Payer.

• A Claim can appear to be Payer Accepted, but the Claim has not yet been adjudicated.

• If the Payer is contacted, the Claim will not be on file until it is adjudicated.

• The manual process for checking a Claim's status is extremely time-consuming, costing valuable User productivity for your practice.

• Long hold times

• Navigating IVR systems

• Inquiries on many different Payer portals that have short password expirations.

• Lock outs for bad login attempts.

• The result is lost revenue.

Advantages of using Real-Time Claim Status 

• Real-Time Claim Status (RTCS) is an electronic method of getting an immediate Claim Status update from the Payer. If the Claim shows a Status of Payer Accepted on the Encounter Dashboard and the Payer offers RTCS, the option Check with Payer link will be available for checking Real-Time Claim Status. (Encounter Dashboard > Policy Breakdown panel > Insurance line > Check with Payer)

• Since the Claim has reached adjudication, there will be no wasted User time contacting the Payer before adjudication.

• The Last Checked Date makes it easy to view the last Claim Status results and should also help prevent unnecessary Real-Time Claim Status checks.
• When RTCS is used, the exact same information that was sent in Claim Loop 2010AA will automatically be sent on the Claim Status Request.

• This is EIN/SSN and NPI of the entity to whom the Insurance Payment is directed.
• It ensures proper matching and response from the Payer.
  
• This information is required whether checking Claim Status using RTCS or manually checking.

• Real-Time Claim Status can be configured to run automatically using the Job Scheduler, eliminating the need for User intervention.

Payers with Real-Time Claim Status

On the Enrollment screen and the Clearinghouse Payer List, you can view a list of Payers that offer Real-Time Claim Status.

• Home Dashboard > Enrollments button

• To see the ones that need Enrollments to be completed, select Only for Enrollment Required (scroll to the right). Select Search.
• To see all of the Payers that offer Real-Time Claim Status, select Include for Enrollment Required. Select Search.

• The Action column will display whether the Payer requires Enrollment.

• Admin > Clearinghouse Payer List button

• Select Claims Status for Type.

• This will produce a list of all Payers with Real-Time Claim Status along with Payer ID and the State designation if applicable.

• To see only the ones that need Enrollments, select Claim Status for Type, and Yes for Enrollment Required. Select Search.
• To see Enrollments for your State only, select Claim Status for Type, Yes for Enrollment Required, and select your State in the State filter. Select Search.

• Enrollments must be done from the Enrollments button on the Home Dashboard.

Learn More

• Automate Real-Time Claim Status with the Job Scheduler