Before you get started:
- All claims generated, whether they be Paper or Electronic in CoAction, 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 CoAction, 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, CoAction 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 certain number of test claims 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)
Info for CoAction Cloud Users Only:
If this is the first time generating electronic claims in CoAction or on your specific computer
- Create a CoAction Billing Folder on your desktop by right clicking the desktop, select New, Select New Folder.
- Add Submitted Claims folder within the billing folder.
Let’s Generate some Claims!
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 CoAction 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 CoAction 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)
CoAction 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: CoAction 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, CoAction 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.
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”.
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 [here] 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.
If you are generating claims Electronically there are some steps that need to take place, dependent on what CoAction platform you are on.
Instructions for Server Clients Only:
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 in CoAction or on your specific computer*
Follow these onetime steps:
- you will minimize CoAction, leaving this window open.
- Click on the file image, circled in this image.
- Drag and drop to desktop.
- Rename file to “CoAction 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 CoAction, how many images were generated for Electronic Billing and how many failed scrubbing that still need to be corrected.
When finished reviewing Select Finished.
Instructions for Cloud Clients only:
A window will automatically generate stating the following message, Please select OK to bypass.
There will be a window behind this message asking where you would like to save your generated HCFA claims.
You Must Follow these next steps exactly!
- Double Click “This PC” or “Computer”
- Double Click “Local Disk (C: Your computer name)”
- Double Click “Users”
- Select Username Signed into the Computer (on my computer my username is User)
- Double Click “Desktop”
- Select CoAction billing folder to highlight
- Select OK at the bottom of window
You will see the report of how many HCFAs were printed, how many images were generated for Electronic Billing and how many failed scrubbing that still need to be corrected.
When finished reviewing Select Finished.
Training Video Reference
Please keep in mind, this is an old training video and may not provide a full explanation but, is provided for a visual walk through.