So, the Pacific Blue Cross claim got rejected, ugh. It happens. The good news? You can still bill the patient directly in Jane with a few short steps.
Let’s walk through it together 💙
Start by heading over to the Billing tab, scrolling down to the Claim Submissions section and click on the Rejected folder. This is where all those not-so-successful claims hang out. Find the claim you need to work on, click the little dropdown arrow next to the invoice, and then select Edit Purchase.
Once you’re in the purchase edit screen, scroll down until you see the Insurance section. Look for the field labelled Max Amount and set it to $0.
Jane will then push the total visit amount to the patient and mark the claim as Unpaid/Unsubmitted. It’s important to note that this process won’t delete the record. This tells Jane who should be paying for this visit.
Wait, Why Doesn’t Jane Do This Automatically?
Excellent question! Jane gives clinics a bit of flexibility here. When a PBC claim gets rejected, it doesn’t automatically pass the balance to the patient, even if Patient Pays Remaining is turned on. Why? Because you’ve got options:
- You can resubmit the claim (maybe it was just a typo or missing info).
- You can write off the amount (if you’re feeling generous or it’s policy).
- Or, you can bill the client directly, which is what we’re doing here.
Additional Resources
You can also check out our Pacific Blue Cross - Reversing Claims Through the PROVIDERnet Integration guide for more information on how you can reverse the claim, make quick edits and resubmit all within Jane.
We know managing rejected claims can be a bit challenging, so please reach out to us if you have any additional questions!