If the module is not available, please ask your system administrator to give you the appropriate permissions. You can also view and edit billing information from the Processing module by clicking the Billing Edit button or double-clicking the required service.

EMSOW’s Billing module allows you to add transactions using electronic claims, paper statements and superbills.

An electronic claim is a detailed invoice that a health care provider (such as a doctor, clinic, or hospital) sends electronically to a health insurer.

Paper statements are used when there is no possibility to send the claim electronically.

A superbill is an itemized form used by healthcare providers for reflecting rendered services. The superbill is the main data source for creation of a healthcare claim, which will be submitted to payers (insurances, funds, programs) for reimbursement.

The left sidebar provides a search filter with numerous search options. You can use various search parameters, such as the date of service (specific date or date range), order ID, service ID, patient name or date of birth, tags, referring doctors and many others.

There is also a Query list on the left sidebar in the Billing module. Using this list you can add up to four additional queries to the primary query that you set in the General section. These queries are joined using the logical operator AND, while conditions within one query are joined using OR. The available queries are:

After you have specified the necessary fields, click the Search button to find the appropriate studies. To reset all fields, click the Clear button. The Reload button allows you to reload the search results. It can be useful after you have changed some of the search fields.

On the top of the list of studies, you can see the status bar which displays how many studies, services, patients, bills etc. were found:

Below the status bar, you can see the toolbar:

Print – use this button to generate PDF files of patient lists, superbills, eligibility forms, superbill packages, account statements, patient demographics, HCFA-0805 and HCFA-0212 forms, Medicaid forms.

Report – use this button to generate various reports, such as referring doctor reports, rendering statistics reports, payment analyses, reimbursement analysis reports, write off analyses, insurance breakdown reports, summary aging reports, summary billing reports, monthly reconciliation reports, cash collection reports, end of month (EOM) reports, submission logs, reports of repeated studies, denials reports, client reports, invoice reports, pending reports, write off reports. You can track the readiness of the Monthly Reconciliation Report and End of Month Report in the Reports module. To find the module, follow the path BILLING → Reports.

Submit – use this button to submit electronic claims, superbill packages, paper statements, and invoices.

Add transaction – use this button to add transactions, such as superbills and patient statements.

Copy – use this button to copy text information displayed in the study’s record. Then you can paste it into any text editor.

Service – this button opens a drop-down list of service operations for the study: Service edit, Billing edit, Move, Documents, and Apply tags. Click Service edit to open the service editing window, where you can change the type of study, diagnoses, the referring doctor etc., like in the Processing module. Click Billing edit to view and edit billing information (see more details below). Click Move to move a study to the processing stage or to the billing stage. Click Documents for viewing, uploading, and deleting documents attached to a study. Click Apply tags for tagging studies.

Eligibility – this button allows you to check whether the insurance is valid or expired.

Auto fill – use this button to assign the reading doctor and billing company automatically for the selected studies.

Prepayments – click this button to open the Prepayment Analysis window:

In this window you can see the list of prepayments. Double-click a payment or select it and click the Show details button to see its details. To make a prepayment, click the corresponding button. The Export button allows you to export the list of prepayment to an Excel 2007 file. To refresh the list of prepayments, click the Reload button.

Choose the required study and click the Edit button. As the result, the pop-up window will open:

It consists of four sections: Options, Readings, Billing operations, Billing procedures. In the Options section, you can add and remove tags. You can also disable any reading or billing processing for the study by selecting the “Disable any reading processing for this study” or “Disable any billing processing for this study” checkbox. You can also use these checkboxes to run a report on the attributes No read or No bill. You will see these attributes in the Invoice report. The No read attribute will be displayed in the Reading doctor and Reading facility columns and the No bill attribute in the No bill column. In the Readings section you can select the reading facility and the reading doctor, as well as set up the amount of fees payable to the reading doctor. In the Billing operations section you can add and remove billing operations, set up the billing company, the doctor, tags, and fees. In the Billing procedures section you can add and remove billing procedures, set up diagnoses, units, modifiers and Dx pointers (diagnosis pointers). After the changes are made, click OK to save the information or Cancel to quit without saving.

In the Transactions section you can add transactions by clicking the Operations button and selecting the required operation in the drop-down menu. The available operations are: to charge an amount, rebill (to a patient/insurance), add a superbill (for a billing company), add an electronic claim (for an insurance), add a paper statement (for a patient/insurance), post a payment (from a patient/insurance), post a denial, write off an amount, close billing, and reopen billing. After you have added the transaction, it will be displayed in the window:

To remove a transaction, use the Remove selected transaction button. The Print billing history button allows you to generate a PDF file with billing history.

In the Notes section, click the Add button to add a note. In the pop-up window you can link the note to a service or study, select the type and the subject of the note, and enter the text of the note. To edit an existing note, click the Edit button. To delete a note, click the Remove button.

2. Click Add under Billing operations and fill out the following fields:

• Company – select the billing company you are going to bill through (see SETUP → BILLING → BILLING COMPANIES).
• Bill by – this field is only required if the provider that must be on the claim is different from the reading provider;
• Comp. is the component you are billing for. You can select 26 (professional component), TC (technical component) or leave it blank for GLOBAL. If you are billing for multiple components, create a billing operation for each of them.
• Tags are billing tags that you would like to add to this operation (see SETUP → BILLING → TAGS).
• Fee $ and Fee man. – these fields specify the fee you will be paying to the billing company for this operation. If you want to manually assign it, select yes under Fee man. and enter the fee amount under Fee $. Alternatively, you can set the fee in the billing company options (see SETUP → BILLING → BILLING COMPANIES) and select no under Fee man.; then the fee amount will be assigned automatically.

3. Then click Add under Billing procedures, select the billing operation that you added earlier, fill out the procedure and the number of units for this procedure, add modifiers to the procedure if required, and put diagnosis codes in the correct order for this study (note the Dx pointers column). When finished, click OK.

4. Now, in the billing information window for the service, add a charge to the study record by clicking Operations → Charge amount (the study should be selected under Billing operations in the bottom-left corner of the window).

5. A new window will appear. Select the payer you want to add the charge for and check the amount you are charging. Edit it if required. Click OK.

6. The system will automatically add a “rebill” transaction for the payer as well as an electronic claim.

Repeat steps 1 to 6 for every study you need to bill for.

7. To submit claims, go to BILLING → CLEARING and click the Submit button.

8. In the Available not sent claims window, select the claims you want to submit, and send them by clicking the Send button. The system will take some time to process the claims, after which you will see a new request (REQ) file.

If you use the Claim.MD clearing house, a few additional things need to be mentioned:

1. For every insurance you bill through Claim.MD, you need to add a claims payer ID to the billing connector. Here is how to do this:

1.1 Go to SETUP → BILLING → BILLING CONNECTORS. Double-click the Claim.MD connector. In the billing connector settings, switch to the Payer IDs tab. Click Add → Manual.

1.2 Select the insurance you would like to add a claims payer ID to, and enter their ID in the Claims payer ID field. The payer ID list is available from https://www.claim.md/payer/. When finished, click OK.

2. After you submit a claim, you may want to reach our support team and ask them to see the .result file to make sure that the claim has been received by Claim.MD. Here is how to do this:

2.1 In the Clearing module, add the Other type under General and run a search. The result file must follow the REQ file.

If you have any questions, feel free to contact the support team over email or over the phone.

If the module is not available, please ask your system administrator to give you the appropriate permissions.

The left sidebar provides a search filter with numerous search options. You can use various search parameters, such as the date (specific date or date range), file types (claim request, claim response, ERA/EOB, eligibility, other, unknown, and hidden), and status. You can also specify and track file information. After you have filled out the necessary fields, click the Search button to find the appropriate clearing files. To reset all fields, click the Clear button. The Reload button allows you to reload the search results. It can be useful after you have changed some of the search fields.

On the top of the list of clearing files, you can see the status bar which displays how many results were found. Below it, you can see the toolbar:

Submit – use this button to send claims. After you click the button, the pop-up window will open:

In the left part of the window, you can see the search filter that contains various options such as the date of service, billing companies, and insurances. Click the Search button to find the appropriate claims. To reset all fields, click the Clear button. The Reload button allows you to reload the search results. It can be useful after you have changed some of the search fields.

In the right part of the window, you can see available claims that have not been sent. You can select or deselect them by clicking the checkboxes as well as clicking the buttons Select all or Deselect all. The Hold until manual release checkbox allows you to postpone sending the selected claims (to send these claims you will need to click the Release button on the toolbar).

After you have selected the required claims, click Send to send them or Cancel to quit without saving.

Post – use this button for posting ERA/EOB files. After you click this button, the pop-up window will open:

Select the required services and payment method, set the check’s deposit date (optionally) by clicking the checkbox and selecting the date, and then click Post to post the ERA/EOB file.

Archive – use this button to archive the ERA/EOB file and hide it from the results window of the Clearing module. To have access to this function, your user group must have the permission “Claims clearing – archive/unarchive ERA/EOB file(s)” (please ask your system administrator to grant you this permission).

Unarchive – use this button to unarchive ERA/EOB files.

Release – use this button to send claims which were postponed by using the Hold until manual release checkbox in the Available not sent claims window.

Reset – click this button to reset the processing status for the selected files.

X12 dump – click this button to display the content of the selected X12 document as a text file.

X12 tree – click this button to display the content of the selected X12 document as a tree structure.

Furthermore, there are two buttons to the right of the toolbar:

Upload ERA/EOB – use this button for uploading ERA/EOB files. After you click this button, the pop-up window will open:

Select the connector and the path to the file, and then click Upload.

Export – this button allows you to export the search results to an Excel, Excel 2007, CSV, PDF, or HTML file.

In the list of clearing files, you can mark a clearing file as read or unread by clicking the green circle next to it. Click the flag icon to mark the file as taken into work.

Click on a clearing file to view it. As the result, the pop-up window will open:

You can switch between tabs to view the file information, batches, claims, and lines, as well as to view the file in various representations, such as text, X12 text, X12 tree, X12 dump, and PDF. When you select the PDF tab, you can select Form with graphics (1 page) or Form with graphics (all pages) to view the file as if it was printed on a health insurance claim form. Select Form only to display only the file’s contents so that you can print the file on a paper claim form. Click the Editable checkbox to have an editable PDF file. If you need to download it, click the Download PDF button. At the bottom of the window you can see several buttons:

Copy to clipboard – this button allows you to copy all the text displayed in the window to the clipboard. This is available only in the Info, Text, and X12 dump tabs.

Download Original File – click this button to download the original clearing file that you can see in the Text tab.

View Original File – click this button to open the original clearing file in a new browser tab.

Download Preview File – click this button to download the PDF file.

View Preview File – click this button to open the PDF file in a new browser tab.

OK – click this button to close the window.

To run either of these reports, click BILLING → BILLING → Report → Monthly Reconciliation Report / End of Month Report. When the report is ready, you will get a push up notification with a link to download the report. You can also download the report directly from the new module, where all generated reports remain available for one month. Moreover, you will receive the download link via e-mail if you specified an email address in the contact information of your account.

There are the Options and Generated files sections in the module. In the Options panel on the left sidebar, specify the search parameters as necessary. You can search files either by Queued date or Completed date. The search results will appear in the Generated files panel. The list of reports is arranged in several columns: ID , Name , Queued , Generation time , Completed , and Actions .

Reports that are ready to be downloaded are marked with the green dot and highlighted in gray. As you download the file, the dot becomes gray. You can mark important files with this green dot, just click the dot next to the file. Click the name of the file to download it.

Here is the module layout:

In section 1 you can see the searching tools:

• Date – specify the date or period of time.
• Amount – specify the amount of collections.
• Ordering facilities – choose one or more Ordering facilities.

After you click “Search”, section 2 will be filled with specified collections.

In section 3 you can see the tools for operating collection entries:

• Add new – creates new entry. Here is the dialog window for adding new entry:
  

  Here you can choose Ordering facility, Enter and later Choose existent Sources of collection, Date and Amount of payment, and write down the comment if needed.

• Edit selected – opens entry editing dialog window. Edit dialog window looks exactly the same as the previous one;
• Remove selected – deletes selected entry;
• Copy to clipboard – copies entry data to the clipboard;
• Export – saves the entry data to .xls file.

Section 4 contains tools for navigating the list of entries.