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Module 2: Claim Submissions & Management

As a US Biller, there are 5 learning modules for you to walk through before you get up and running with Jane’s insurance features:

Learning Modules Complete
1. Setting up insurers, billing codes, and billing info 🥳
2. Claim submissions & management ✍️
3. Modifiers, creating a custom billing code, changing and adding billing codes
4. Remittances
5. A/R tracking (aging claims)

 

💡Jane Tip: We recommend heading over to Jane’s Demo Clinic to practice as you learn! Log in as the ‘owner’ profile for Full Access to the features we’ll be talking about. You can find the login password to access the Demo Clinic by heading to the Jane Community Group on Facebook and clicking the ‘Featured’ tab. If you’re having any trouble, you can also request the password by email ([email protected]).


Module 2: Claim Submissions & Management

Alright, now that we’ve gotten through the basics of getting the clinic set up for submitting insurance, it’s time to take a look at actually submitting the claims and the differences between electronic and paper submissions.

Feel free to scroll through the guide, or hop to a specific section below:


Claim Submission Folders

 

All insurance claims are managed under the main “Billing” tab in Jane.

The “Claim Submissions” area, found on the left, has several folders to keep all patient claims accounted for during the submission process.

Let’s get to know a few of the Claim Submission Folders:

  • The Draft folder is an optional folder used for reviewing claim information. You can set up your account so that all new claims start here. This folder can be helpful if you have dedicated billing staff who need to easily know which claims have been finalized (i.e. all billing codes have been entered) and are ready to be submitted. When your draft claims have been finalized, they can then be moved to the Unsubmitted folder by the practitioner.
  • The Unsubmitted folder holds all insurance claims ready to be submitted. This is where new EDI files are generated.
  • The Submitted folder holds any claims that have been submitted, and are awaiting remittance from the insurance company.
  • The Approved folder is your “Done” folder! It holds all claims that have been marked as paid or a response has been received.
  • Can’t find a claim? Use the Search function.

CMS-1500s & EDI 837ps - What’s the Difference?

EDI 837p

Electronic Data Interchange (EDI) is the electronic exchange of business information in a standard format. Simply put, EDI is how different entities send and receive large amounts of data efficiently. These files are used for electronic submission through clearinghouses, in our case you can submit an EDI created by Jane to these clearinghouses:

CMS-1500

CMS-1500 is the standard paper claim form used to bill insurance for rendered services and supplies. It provides information about the client, their corresponding insurance policy, and their diagnosis and treatment. This information is the same that’s included in the EDI file, just organized for human eyes to read, as opposed to a computer.

If you do choose to go with paper submission, or even if you just need to understand where certain information is populating from in Jane, we’ve created this handy reference sheet for you to use: CMS-1500 Reference Sheet.


Generating an EDI File for Claim Submission

 

To submit claims electronically,

  • Head to the main Billing tab > Unsubmitted folder
  • Select the claims you’d like to include in your batch.
  • Click the Submit Selected Claims button at the bottom of your screen and continue to the Pre-Submission Checklist.

  • Once all the fixes are made, then you can generate your EDI file.

  • Click the blue Download button once to download one EDI file that includes all of these claims/dates of service and then upload this file to your clearinghouse account.

And voilà!

You can now submit this EDI file to your clearinghouse.

All submitted claims will now be moved from the Unsubmitted folder area, over to the Submitted folder awaiting payment.

Practice Drill 🏈

Hop on to the Demo Clinic to do this next exercise!

Instructions:

  • Head into the Billing tab at the top of Jane and then select the Unsubmitted folder.
  • Select a claim by clicking on the item, highlighting it blue.
  • Click the Submit Selected Claims button at the bottom of your screen and continue to the Pre-Submission Checklist.
    • Fix any errors (marked by red boxes) that pop up on the submission by clicking Edit beneath the notice.
  • Once the claim is ready for submission, continue to Generate Submission for 1 Claim.
    • Note that the claim will now be moved to the Submitted Folder once this is done.

Touchdown! 📣


Resubmissions & Corrected Claims

If you’re using Jane’s EDI feature to submit to a clearinghouse and you need some help resubmitting corrected claims, then we’ve included this handy guide doc for you here: Managing Resubmissions & Corrected Claims.

As always, if you’d like to read further on creating and submitting EDI files in Jane, we’ve put together a very handy resource guide you can view in Step 5 of our US Insurance Billing Training


CMS1500 - Health Insurance Claim Form

 

Jane can generate a CMS1500 form into an editable PDF for paper claim submission.

Once you have Arrived an appointment and have added in all insurance claim information, you can click the downward arrow next to the “Pay” button and select Generate CMS1500:

From the Draft or Unsubmitted folder, you can also generate a CMS1500 form by clicking the right side arrow, and selecting View Purchase. Jane will tell you if there are any missing fields and then generate the form:

This form can now be Printed, or edited further if required. For editing, it’s best to Save the form first and then make any needed edits to the downloaded copy.

The CMS1500 Forms will print best on blank paper. Some Payers can’t process the claim if it is printed in black and white, so printing in color is generally a good idea.

📍 Note: SOF stands for Signature on File. This is an accepted term but feel free to remove this if you are printing and signing.

Need a little help figuring out what’s supposed to go into each box (and where that info is coming from in Jane)? Check out Start Billing 4: Claim Management & CMS1500 Forms or take a look at our guide on Insurance claims and the CMS1500 or our CMS1500 Reference Sheet.

Batch CMS1500 Forms

Want to export multiple CMS1500 forms in one go? If so, check out the following guide: Generating a Batch: CMS1500s.

Practice Drill 🏈

Hop on to the Demo Clinic to do this next exercise!

Instructions:

  • Head into the Schedule tab and select an appointment on the schedule with insurance attached.
    • You can easily find which appointments have insurance attached by the briefcase icon on their appointment.
  • Arrive the appointment and select the dropdown menu next to Pay
  • Click Generate CMS1500

Touchdown! 📣


Excellent! 🥳 Now that we know how to generate our submissions, let’s head on to Module 3: Modifiers, creating a custom billing code, and changing & adding billing codes.