Why doesn't my claim queue?
Posted by Dustin Taylor on 03 June 2013 03:34 PM

Author: Cari Callan

Issue: Charges have been entered for a patient but a claim will not queue.

Solution:

  1. Go to the patient's ledger.

  2. Find the service line (charge code) in question and double click on the line.

  3. Click on the claims tab to verify that a claim has not been created.
    Charge Details

  4.  If there is not a claim present, close the details box.

  5. On the left, in the action panel, click Pending Analysis.
    Charge Details
  6. Click on the Transaction Eligibility tab.
    Charge Details

  7. 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.
        Incident
      • CPT by Carrier – In Carrier Registration, under CPT Translations and Allowed Values, the check box for Allow Claims Processing is unchecked.
        CPT translations

      • CPT – In Charge Code Setup, the check box for Allow Claims Processing is unchecked for the specific CPT code.
        CPT
      • Tran Claims Override/Plan Type – While entering charges through Transaction Posting, the option to ‘Don’t Process’ claims has been chosen.
        CPT
  8. 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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