In this article, you'll learn about our RCM updates to:
Claims Status Clarification
The claims status options have been updated to provide greater clarity.
Claims Status Updates
The following updates were made to claims status labels:
1. Accepted by CLH was renamed Submitted to CLH
To provide greater accuracy, the status was renamed to Submitted to CLH to be more reflective of the actual status that the claim has been generated and sent to a Clearinghouse for their review.
2. Accepted by Payor was renamed Submitted to Payor
To provide greater accuracy, the status was renamed to Submitted to Payor to be more reflective of the actual status that the claim has been transferred by the Clearinghouse to the payor for their review.
Note: all messages received from a Clearinghouse and/or Payor are placed in the History & Notes tab for your reference.
All new statuses and labels are applied to previously created claims by default.
Claim Label Updates
Claim labels provide further clarification of a claim's progress.
The following claim labels have been added:
1. Message from CLH
Message from CLH will display when a status claim update has been received from the Clearinghouse. This label can display for the following statuses:
- Submitted to CLH
- Rejected by CLH
The label will no longer display when the status of a claim changes.
2. Message from Payor
Message from Payor will display when a status claim update has been received from the Payor. This label can display for the following statuses:
- Submitted to Payor
- Rejected by Payor
This label will no longer display when the status of a claim changes.
Improved Documentation of Claim Changes
To improve visibility on claim changes, the History & Notes tab identifies who and when claim changes were made while the claim is being edited.
Note: when editing a claim, the claim status is automatically changed to Not Submitted.
Claim changes are documented during the following steps:
1) Click Edit to make changes to a claim, noting that the claim status is Submitted to CLH.
2) Confirm by clicking Edit Claim.
3) The claim status is changed to Not Submitted.
Navigating to the History & Notes tab, it is documented when and who initiated the edit.
Identify Primary Diagnosis
Since some insurance companies require specific diagnosis order for claim reimbursement, a diagnosis can be marked as Primary in a claim to decrease rejections and increase reimbursement timeline.
By default, the first diagnosis assigned by a practitioner is marked as Primary in the claim. This default can be manually adjusted with the following steps:
1) Go to the Claims tab and click on the date of the desired claim to open its details.
2) To change the primacy of the diagnosis, click on Edit.
3) Click on Mark as Primary.
4) The diagnoses will be reordered with the Primary diagnosis as first on the list. Hit Save to save changes.
You can now submit the correction. The CMS1500 also identifies which diagnosis is primary.