In this lesson we’ll cover the following Claim Submission topics:
Claim Submission Folders
All insurance claims are managed under the main Billing tab in Jane.
The Claim Submissions area found on the left, has a number of folders to keep all patient claims accounted for during the submission process. If you’d like, you can join Sophia from the Jane team as she walks through a few of the improvements made to the claim submission experience.
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.
- The Waiting on Primary folder holds any secondary claims that are awaiting primary claims’ adjudication. These secondary claims will automatically move toward your Unsubmitted folder (or Draft if you use this as your review area) once the remittance for any relevant primary has been recorded.
If you are interested in using the draft folder as a “review” area, you’ll want to set up this default by heading over to Settings > Billing Settings > Set New Claim Submissions As… and select “Draft” from the drop-down menu.
If you’d like to dive deeper into a claim, you can click the View button to open up the Claim Summary.
The Claim Summary panel shows you everything you need to know about a particular claim. You can see information about the patient’s insurance policy, the date of service, billing codes, and any submissions you’ve already made towards this claim, any claim responses you’ve received, and even if they have any secondary coverage!
If you need to dive even deeper into a claim, you can click the dropdown arrow at the top of the panel for a list of additional options!
CMS1500 - Health Insurance Claim Form
Jane is able to generate a CMS1500 form into an editable PDF for 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 our guide to 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
📘 Continue learning the insurance billing workflow in Start Billing 5 - EDI Files for Claim Submission.