Guide to Reconciling Claims Manually

This guide is essential for anyone managing claims, as it provides step-by-step instructions for manually updating claim statuses when automatic updates are unavailable. It emphasizes the importance of accuracy in financial records, offering detailed methods for marking claims as paid or denied, including how to enter payment and adjustment information. With this guide, users can efficiently navigate outstanding claims and ensure proper documentation for reconciliation, ultimately streamlining their billing processes.

Please note that if you use the billing integration, manual claim updates are generally unnecessary, as claims are automatically updated when the ERA is received by Claim MD. This feature should only be used in specific cases where the ERA is unavailable or delayed

Please note that if you use local billing, billed visits will be marked as paid by default. To manually post this information, disable the Local Billing Auto-Posting setting.

1. To do this, go to Agency > Settings > Billing, disable the setting, and save the changes. Once disabled, any locally billed claims will remain outstanding until manually updated.

Locate Outstanding Claims

2. Navigate to the History section and open a specific billing group to view the claims within that group.

3. Select the claims you wish to update

4. Click "Actions" and choose the desired action:

  • Set as Paid or
  • Set as Denied

Marking Claims as Paid

5. Click "Set Selected Claims as Paid"

6. View Selected Claims

After selecting Set as Paid, you will see the selected claims along with their associated charges.

For each claim, the following details are displayed:

  • Provider
  • Procedure Code
  • Charge
    • Date and Time
    • Billed Amount

7. Enter Payment Information

  • You can manually add the Payer ICN

8. - For each charge you can enter the Paid Amount (by default you will see the billed amount)

9. You can add Adjustments as needed:

  • Specify the Adjustment Amount
  • Choose the Adjustment Code
  • Select the appropriate Adjustment Group

10. Save Changes

  • Review the details of each claim and save the updated information to reflect the changes

Marking Claims as Denied

11. Select Set Claims as Denied

12. You will see the selected claims and their charges with the same detailed information

13. Enter Denial Information

You can manually add the Payer ICN and the Error Message

14. For each claim, classify it as:

  • Denied: The claim is valid but not paid by the payer
  • Rejected: The claim has errors and is not processed by the payer

15. You can add Adjustments if applicable:

  • Specify the Adjustment Amount
  • Choose the Adjustment Code
  • Select the appropriate Adjustment Group

16. Save Changes

Verify the information entered and save the updates to reflect the claim's denial status.

Claims manually marked as Denied will go to the Denied claims section and you will be able to re-submit them from there:

  • If you use the billing integration, the claim will be resubmitted to Claim.MD.
  • If you use local billing, the claim will be resubmitted locally and can be found in the Billing History section.

Updating claims from the Accounts Receivable Aging Report

17. You can also post claims as either Paid or Denied through the Accounts Receivable Aging Report. This report helps you monitor and manage the status of claims and outstanding balances efficiently.

  • Always ensure the information entered is accurate to maintain proper financial records.
  • Use the classifications (Denied or Rejected) appropriately based on the payer's response.
  • Adjustments should be documented with correct codes and amounts for reconciliation purposes.