✨PSST!✨ Before we get started, there must first be an Invoice on file associated to an Appointment! You can CLICK HERE for a refresh on creating an Invoice if you need to 😉
Sending out Claims can be an essential part of the day-to-day operations of your practice, which is why we want to make this as streamlined as possible! We’re going to break this down into a few sections for you…
First, let’s start with a simple Checklist to make sure you are set up for success! 📋
Do you have the following set up?
Add ICD-10 Codes by going to Settings > Insurance Settings > ICD10 Codes
Add CPT Codes by going to Settings > Insurance Settings > CPT Codes
Add your Tax ID by going to Settings > Insurance Settings > Tax IDs
Add your Tax ID to your Clinic Information by going to Settings > Location Settings > Clinics
Add in key Service Charges by going to Settings > Product, Invoice and Payment Settings > Products
Note: You can add CPT codes to Services such as Adjustments or New Patient Fees. While you CAN add more than one CPT Code, we recommend having a max of one added for optimal mapping! CPT Codes are not required here, however, they do assist with streamlining the Claim creation process, as well as assist with streamlining the creation of Invoices to send to HSAs, and HRAs.
Make sure that the Patient has the following information entered in their Patient Profile by going to Patients > Patient Profile > Details:
Full Name
Sex/Gender
Date of Birth
Address
Phone Number
Insurance Company
Awesome! Now that we’ve completed that quick list, let’s get those Claims created!
In Clerk, Claims are created from the Invoices that are made from checking a patient out after their Appointment. For this reason, Invoices must be associated with the patient’s Appointment. There are a few ways that you can create a Claim in Clerk.
The most streamlined process of creating a Claim will be during the Checkout process, where you can Queue the Invoice as a Claim:
From there, you will either want to head over to the Patient Profile > Financials Tab and scroll down to Claims OR go to Reports > Insurance Reports > Insurance Claims. Once you find the desired Claim, click into it to bring you to a prettier version of your HCFA Form!
Clerk is intuitive, and should not allow you to submit a Claim that is not fully filled out. Clicking Next Step on the bottom will allow you to navigate through the tabs at the top. If any of the required fields aren’t properly filled out, Clerk will alert you with the areas that need to be filled out by highlighting them in red:
If you happen to navigate through the tabs at the top, Clerk should still tell you that you have missing information by showing you the following at the very end of the Claim:
Once everything looks good, go ahead and submit your Claim!
✨Note:✨ If you are sending Claims to attorneys, you will want to select Yes in the Personal Injury Case? dropdown under the Insured tab.
This will manually change the Claim Status to Submitted to Attorney:
What's that? You want to know how to check the Status of a Claim? 👀 We thought so! You can CLICK HERE to learn how to do just that!