How do I make sure that all approved visits are billed?

When generating claims, you will receive a background job report if the claim generation background job fails or is only partial successful. You should make sure to resolve the errors identified in the error report right away to ensure that the affected visits can be included on a claim so your organization can receive payment.

If you wish to check whether you have any unbilled visits for electronic billing payors, you can run the Unbilled Visits Report from the accounting export tab. You can use this report to identify which visits have not yet been billed and which payors have claims that require further action. 

Reviewing and resolving claim generation errors to prevent unbilled visits

In the electronic billing summary v2 page, you will see the status of the most recent background job run for each electronic billing payor.

There are two possible types of background jobs that can be run for claims:

• Claim generation jobs.
• Claim sending jobs. 

The status of the background job can be success, partial success, or failed. 

• For a claim generation job, a status of success indicates that all scheduled visits during the selected date range were included on claims. No further action is required.
• A status of partial success indicates that some but not all scheduled visits during the selected date range were included on claims, and further action is required to resolve the errors blocking claim generation.
• A status of failed indicates that there were no new visits that took place during the previous claim generation frequencies. No claims were generated for this funder. No further action is required.

For claim generation jobs with a status of partial success or failed, click view to open the list of claims for the payor. 

You can then select the icon beside the claim generation status to review the reasons why not all visits could be successfully grouped into claims. 

Note that if the last background job run for the payor was a claim sending job, you will need to select generate claims again to view the error report. 

The following situations will generate error messages:

• The same date of service appears on multiple claims. In this situation, you should void the existing claim causing a conflict and regenerate the claims so that all visits on the same day can be grouped together.
• The effective date of the bill code was after the visit date, which prevented all claims using that billing code from being generated. The effective date on the bill code should be set prior to the earliest scheduled visit after which all visits using this bill code will be generated into claims. 
• There were no new visits that took place during the previous claim generation frequencies. No claims were generated for this payor.

Any claims identified in this background job report must be voided as they will prevent newly scheduled visits from being included in claim generation due to scheduling conflicts.  A scheduling conflict is defined as any situation in which a visit was scheduled in the past on a date of service that matches a visit already in a claim for the same date. Making sure all claims identified in the background job report are addressed in a timely manner will ensure that scheduled visits do not go unbilled.

Voiding claims to resolve claim generation errors

If you are using a clearinghouse to send claims electronically to payors, complete the following steps to void claims of various statuses that are identified in the background job report:

• Claims in draft and prepared status can be voided directly, and claim generation can be run again immediately after voiding the claims.
• Claims in paid or denied status must be voided and resent to the payor. When voiding, select the option void claim in AlayaCare and resend to clearinghouse. You will then need to resend the voided claim to the clearinghouse. Once the voided claim is resent, claim generation can be run to include any unbilled visits.
• Claims that are in a sent, acknowledged, or accepted status will need wait until they move to a paid or denied status before they can be voided and resent to the payor.

If you are manually exporting claims to send to payors directly, complete the following steps to void claims of various statuses that are identified in the background job report:

• Claims in draft and prepared status can be voided directly, and claim generation can be run again immediately after voiding the claims.
• Claims in a paid or denied status will need to be voided and resent to the payor. When voiding, select the option void claim in AlayaCare and resend to clearinghouse. The claim will be moved to a prepared status and can then be resent to the payor as a voided claim. The voided claim will be included in the 837 claim export that will need to be uploaded to the payor portal so that the payor is aware of the voided claim. 
• For claims in a sent status:
  • If the 837 export has not been uploaded to the payor portal then the claim can be voided by moving it to a denied  status, adding an ICN (required to void the claim and can be any numeric number), and then manually changing the status to void. When moving the claim to a void status, make sure to uncheck the add transaction option. You will then be able to void the claim.
  • If the 837 has been uploaded to the payor portal, then a payor response will be required to void the claim as an ICN (provided by the payor) will be needed. The claim will need to be uploaded to a paid or denied status (based on the payor response). Once the claim is in paid or denied status, it will need to be voided and resent to the payor. 

Using the unbilled visit reports to address claim generation errors

A new accounting export called the Unbilled Visit Report is available to organizations using electronic billing v2 to view a list of any approved visits that have not yet been billed.  AlayaCare recommends running this report to verify that no approved visits are unbilled.

To generate the unbilled visits report, go to accounting>accounting exports and select +add accounting export.

Select Unbilled Visits Report as the type.

Enter a start and end date and select whether you wish to exclude cancelled visits from the report. You can also choose to run the report only for certain clients or payors. When you finished, click save.

Once the report is ready, click the Unbilled Visits Report button under download to download the CSV file.

All approved visits that have not yet been billed will be listed in the report by their electronic billing payor. You can then go the payor's list of claims and void the claims identified in the background job report so that claim generation for all approved visits can be completed successfully.