Jump to: [Before You Begin] [Submitting the Claim] [Add Claim to Claims Awaiting Submission] [Check Claims for Errors & Submit Claim] [Appointments with Multiple Service Types]
Before You Begin
In order to Submit Electronic Claims, ensure the following:
- Must be connected to Apex Clearinghouse.
- Your Client's Insurance Billing Information is setup.
- Client Progress Note for Appointments MUST have a Diagnosis Code in the Note.
- An appointment is created with Service Type(s) included.
NOTE: When multiple service types are included on the appointment, each service type is included on the claim.
- An Invoice is created for the Appointment. You can only generate Claims from Invoices.
Submitting the Claim
There are three steps to Submit Electronic Claim:
- Create the Invoice.
- Add the Invoice to Awaiting Submission - The Invoice becomes a Claim and sits in the Awaiting Submission queue.
- While you Claims are Awaiting Submission, you can perform a general Claim scrub. Claims can be checked for common errors such as Date of Birth, Gender, Address, Diagnostic Code, etc. If a Claim has no errors can be submitted to Apex.
- Claim is submitted to Apex. Here is is check again for errors. All Submitted Claims are sent to Apex each business day at 4:30p CST.
Add Claim to Claims Awaiting Submission
If you didn't immediately add the Claim to the Awaiting Submission tab, you can do so from the Client Ledger.
- Locate Invoice on the Client Ledger.
- Click Actions button and select Add to Claims Awaiting Submission.
NOTE: When multiple service types are included on the appointment, each service type is included on the claim.
Check Claims for Errors & Submit Claim
Checking for errors in WebABA is a simple scrub that checks for missing items such as address, birthdate, Provider, etc. It will not validate that information entered is correct, it is simply searching for missing information.
- Click Billing tab in primary navigation bar. Claims > Awaiting Submission tab displays.
- Select checkboxes for Claims you wish to check.
- Click Check Select Claims for Errors button above.
- Fix prompted errors.
- Select appropriate Claims and click Submit Select Claims button.
Claims will now display in the Submitted tab, where they will sit until they are Accepted or Rejected.
Appointments with Multiple Service Types
When an appointment contains multiple service types they are all submitted on a single claim.
- An appointment is created with one or more service types included.
- An invoice is created for the appointment and includes both service types.
- The claim is added to awaiting submission and both service types are included on the CMS 1500 for the claim.
