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Author: Cari Callan
Issue: Charges have been entered for a patient but a claim will not queue.
Solution:
- Go to the patient's ledger.
- Find the service line (charge code) in question and double click on the line.
- Click on the claims tab to verify that a claim has not been created.
- If there is not a claim present, close the details box.
- On the left, in the action panel, click Pending Analysis.
- Click on the Transaction Eligibility tab.
- The column marked as ‘N’ gives the reason why the claim will not create. The ‘Has Carrier Paid’, ‘100% Paid by Ins’, and Assignments columns do not keep a transaction from being eligible to print on a claim.
- Plan Coverage – Indicates that there is not an insurance plan added to the incident in Patient Registration that the charges are attached to.
- Allow Claims – Indicates that claims have been explicitly prevented in one of several locations. These locations are:
- Incident - In Patient Registration, in the incident that the charges are posted to, the check box for Allow Claims Processing is unchecked.
- CPT by Carrier – In Carrier Registration, under CPT Translations and Allowed Values, the check box for Allow Claims Processing is unchecked.
- CPT – In Charge Code Setup, the check box for Allow Claims Processing is unchecked for the specific CPT code.
- Tran Claims Override/Plan Type – While entering charges through Transaction Posting, the option to ‘Don’t Process’ claims has been chosen.
- Once the area of ineligibility has been corrected, the transaction will be eligible for a claim and will create the next time the claims are queued.
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