Third Party Billing
When a billable item is sent from the proofing screen, and it is has an Insurance Company, it will land in a batch on this screen. The Third Party Billing (3PB) page will show you batches of billable items. These batches can be sent to be billed via a third party clearing house (Emdeon), or printed onto a CMS1500.
Screen
Above is the Third Party Billing Screen, on this screen you will see several columns and buttons that will be explained in this article.
Filter
The filter will allow you to search for a particular batch or a range of batches.
Batch State
Active = Batches that have not been posted to accounting yet. New services can be added from the proofing screen.
Transmitted = Batches are marked as transmitted when they are added to an EDI file, and sent.
Locked = Locked batches prevent new services from being added. In addition, locked batches cannot have items rolled back. You will need to first unlock the batch prior to rolling items back.
Posted = Batches that have been posted to accounting
Date Range
The Date Range parameter is used with the Batch State. This will filter down batches within that range.
To select a custom range, simply click the start date on the calendar, then click the end date. You will see the days between start and end highlight.
When the date is selected, click the Search button to perform the search.
Contact
Contact is an optional field. If you want to find any batches within the date range that contains a particular contact, select the contact from the list.
Insurance
Instead of searching by date, you can drill down to a particular batch for an Insurance Company. First select the Insurance from the dropdown, then a batch dropdown will appear. If there are any batches matching the selected Batch State, they will show. Select the batch name, and click the search button.
Rollback Checked Services
This button is located above the batch information grid, pressing this button will allow you to move items that are currently in a batch back to the proofing screen. To roll an item back you must press the "+" next to the batch to make its details visible. Once you see the individual item you wish to rollback select the checkbox in the detail row, once all items are selected press the "Rollback Checked Services" button. After pressing the button you should see a confirmation dialog stating how many items were rolled back.
*Note* An Item must NOT be posted in order for it to roll back to the proofing screen.
EDI Button
In order for batch information to be transmitted it must be placed into a 837 EDI File. The 837 EDI file is created by using the "EDI" button above the batch information grid, pressing this button will produce a dialog form similar to the one above. On this dialog form there are two list boxes:
Available Batches = All batches that can be transmitted
Included Batches = All batches that will be put into the 837 EDI File. This list by default would include batches that were marked for EDI using the "Select Action" drop down.
These two list boxes can be managed using the two arrow buttons between them, once all the batches you need to transmit are in the Included batches list box press the "Create EDI File" button. Once this button has been pressed the dialog form will change, it will list the status of the EDI files creation and instructions on how to retrieve the file once its been created. After the EDI file has been created all batches that were marked for EDI will be unmarked, if you press the EDI button again the Included batches list should be empty.
*Note* One additional field is the "Test File" checkbox, if this is checked then the process will occur as normal except the batches marked for EDI will NOT be unmarked after the file has been created.
Batch Grid Columns
+ = When this button is selected it will expand the batch to show the individual items in batch. These are usually called the batch's details.
Select Action(Blank Column Header) = Drop down of actions that can be performed on the batch, these are explained individually below.
Insurance Company = The name of the insurance company the batch was created for
Marked for Post(Blank Column Header) = An icon will appear in this column if the batch has been marked for post.
Batch = The name of the batch, a combination of the insurance company's code and the date period the batch is for. A batch can be for a month, a week, a day, this depends on the batching scheme selected for the Insurance Company in list maintenance.
Created Date = The date and time at which the batch was created by an item being sent from the proofing screen to third party billing.
To Send = If this checkbox is checked that means the batch has been marked for EDI.
Transmitted = If this checkbox is checked that means the batch has been transmitted in a 837 EDI File.
Posted = If this checkbox is checked that means the batch has been posted to the accounting system.
Print = Pressing this button will printout out CMS-1500 forms for items in the batch.
Select Action - Post
Using this action will post the batch and all of its items to the accounting system. This will also updated the batch's status to Posted.
Select Action - Mark for Post
Using this action will put a calendar icon in the "Marked for Post" column to indicate that the batch is ready to be posted. This is an optional action, it will not perform any function other than notifying others that would be viewing the screen that this particular batch is ready to be posted to accounting. If a batch has been marked to post selecting the action drop down again will give the option to unmark the batch for post.
Select Action - Lock
Using this action will put the batch into a special Locked status, this status will prevent actions from occurring to this batch. This is an optional action, it is only used for managing batches that you don't wish to be transmitted and/or posted.
Select Action - Consolidate
Using this action will consolidate the individual items in the batch using the consolidation rules recorded in the insurance rate under the payment source. Using the picture above for example, if two items were using this procedure for the same day and the Consolidate action was used then those two items would become one in the batch. Consolidation is used when you're unable to bill for a single procedure being performed multiple times in a certain time frame, usually by day.
*Note* If items are rollback then any consolidations will be reversed, any combined items would split up again.
Select Action - Mark for EDI
Using this action will mark the batch to be used when creating the next 837 EDI file. When a batch is marked for EDI the "To Send" checkbox in its row will be checked and it will automatically be on the "Included Batches" side when pressing the "EDI" button.