Permissions! Clinic Staff must have Administrator, Billing Manager, Billing Assistant, Front Office, or Operations Manager Permissions assigned in order to manage Claim Generation.
Fusion Enterprise understands that billing is a critical function of any practice. As such, we have ensured that you can run all of your practices billing through Fusion Enterprise and make it as easy as we can. This series of introductory articles will cover the important aspects of managing Claim Generation with Fusion Enterprise.
Claim Generation - Historical Tab
The historical tab allows you to retrieve claims that have previously been printed or saved to a file. Claims are retrieved by setting one of the four filter blocks.
The first filter block, By Date Carrier and Case, looks as follows:
These parameters should be filled in to narrow the search as much as possible.
NOTE: It is not advisable to select All Dates, All Carriers, and All Cases, as this can take quite some time to retrieve from the server.
The second filter block, By Output Batch, allows you to retrieve based on a date and time that a batch was created.
This is very useful when a paper jam occurs and all of the claims have to be reprinted. Pulling up the last batch is as simple as setting the date range that the batch occurred in and then selecting it from the drop-down list box.
The third filter block, By Claim ID, allows you to retrieve based on the Clinic Controller-assigned claim ID (the CCT number).
The fourth filter block, By Days Outstanding, allows you to retrieve claims that are still Pending, based on the number of days since the claim was first sent. Inputting 60 would retrieve all claims that were billed out greater than 60 days ago and are still Pending insurance.
After the claims are retrieved, they will populate a grid in much the same fashion as the Current tab.
Historical List Columns
Allows you to specify on which claims you are getting ready to act. A right-click will bring up a menu that will allow you to select or deselect all.
Claim format as set in the patient’s policy, i.e., HCFA, CMS1500, 837, EI
Date the claim was originally output.
Case that was billed for on this particular claim.
Visit that was billed.
Carrier to which the claim was sent.
How the claim was processed. (Paper, File)
Name of the patient on the claim.
After a group of historical claims has been retrieved, you can right-click the grid and see the following menu:
As with Current claims, the Output and Rollback Invoice State options may not be acted upon until the Output List has been filtered down to a single format or claims of a single format have been selected.
NOTE: It is not possible to take a claim that was originally output as one type and convert it to another. If you need to convert to a different type, then the claim type needs to be changed in the policy, and the claim regenerated for that date of service.
After filtering to a single format, it is then possible to re-output the claims in their original format. You also have the chance to rollback the invoice state for a batch of claims. This sets the invoice state back to Bill the carrier.
To accomplish this, select the claims by checking the output box, and then select Rollback Invoice State from the right-click menu.
After selecting this option, you will be presented with the following confirmation dialog:
IMPORTANT: We can’t stress this enough. Make sure this is what you intend to do. Every date of service that is checked off will have its invoice state set to rebill the given carrier regardless of what the current invoice state is set. It would be possible from this dialog to select ALL claims ever billed and roll the invoice state back to rebill. The option is not easily reversible and would require going to each date of service affected and manually resetting the invoice state to the correct value.