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Claims



The Claims menu consists of two tabs: Ready to Work and History.

Ready to Work


Ready to Work is the extended version of the Dashboard line items, Claim with Errors, Delayed Claims and Unsubmitted Claims.



Each claim status category displays the Age of Claim, Patient Name/Subscriber ID, Payer/Payer ID, Date Range and Total Charges. Selecting a claim will generate a synopsis on the right side of the page. The claim shows details, Validation Message and Reason Codes.

Claims with Errors/Delayed Claims


Claim Buttons


  – Gives the option to add a new Professional or Institutional claim.
  – Provides the option to edit, save and submit the claim. General claim details, patient data, payer information and more can be modified.
    – Gives options to suppress for 24 Hours, 48 Hours and Indefinitely. Choosing to suppress Indefinitely will completely remove the claim from the Delayed Claims window, without reappearing in the future. Claims suppressed for an indefinite time frame can be found in the History tab. This option is recommended when a claim requires no further action and needs to be removed from the Ready to Work queue.
  – Displays a new window with the Type of Bill code and Claim type shown in the top left side of the page. Below is a line graph of the claims’ Life Cycle. Each point represents the claim version with the date of correction listed below. Selecting the point will display details of the changes inside each claim version.


Request Details


The bottom left section of the page shows a synopsis of the claim, shows the time frame since the claim was submitted and Request Details. Selecting Request Details provides in-depth details about the claim.


Claim Stages


Shows the various stages the claim has been through. Each status will have a date, time and a unique reference number assigned.


  • Claim Submitted – The claim was submitted by the agency to be sent to the payer.



  • Unknown Response – This status is part of the transmission process.
  • Claim Sent – The claim was sent to the trading partner.
  • Validation Failure – The claim has been validated internally via the Rules Engine and issues were found.



  • Trading Partner Acknowledgment – The trading partner has acknowledged the claim and has sent the claim to the payer. Select View Response Details to view the Claim Response Details.
    • Claim Response Details – Patient and provider details are displayed.
    • Trading Partner Acknowledgements – Shows time, date and Reference ID.
    • Response Details – Indicates claim response codes and specifics.
      • Accepted: indicates claim was accepted. signifies the claim was not accepted.
      • Effective Date: The date claim payment will be effective.
      • Status Type: The current state of the claim.
      • Total Charges: The amount being paid on the claim.



  • Payer Acknowledgment – The payer acknowledged the claim. Selecting View Response Details will generate the Claim Response Details window with the same options as Trading Partner Acknowledgment.
  • Trading Partner Acknowledgment with Errors – The trading partner reviewed the claim and returned it as Unaccepted due to having errors.
  • Payer Acknowledgment with Errors – The payer reviewed the claim and returned it as Unaccepted due to having errors. Selecting View Response Details will generate the Claim Response Details window. Claims with errors have a .
  • Response Delays – When Axxess RCM has not received a response from the payer within the expected time frame a response delay is shown.


Unsubmitted Claims


These claims were created, but not completed. They are saved as a draft. This window displays general claim data including the age of the claim, payer name and date range.


– Once deleted, a claim will be removed from the Ready to Work tab. Deleted claims are completely removed from the system and will have to be recreated.


– Provides the option to edit, save and submit the claim. General claim details, patient data, payer information and more can be modified.

History


This section displays all content submitted to a Payer. The filter options include searching by Subscriber/Patient Name, Provider, Payer, Status, Date Type or Date Range.



The columns provide information on the following:

  • Reference ID/Claim Type – This is a unique 12-digit number in the system used as a method of tracking each claim.
  • Status – This will specify the status of the claim; the following options will display:
    • Submitted: Claims submitted by a user within the agency.
      • Claims with the green Submitted status are Accepted/not yet rejected.
    • Suppressed: Claims that have been suppressed by a user within the agency.
    • Errors: Claims with one or more errors at the Edit, Trading Partner or Payer level.
    • Delayed: Claim has not received a response within the payer’s usual response time.
    • Archived: The status for claims after they are Suppressed.
  • Patient Name/Subscriber ID – Subscriber ID is the numerical version of the patient’s name. Each patient will have a unique ID that will be used as a form of reference.
  • Provider/NPI – Each agency will have an assigned Provider Name (company name). The NPI is tied to each specific agency and is beneficial to users with access to multiple databases.
  • Payer/Payer ID – Each insurance/payer will be listed in Axxess RCM, along with its unique identifier number. The ID is assigned by Axxess.
  • From/Through – This is the date range for the claim.
  • Edited/Updated – When a claim is modified. The system will update this column to indicate the last update date.
  • Total Charges – This dollar amount is the sum of charges submitted on the claim.


– Selecting the Download button will generate an Excel file to be saved based off the filters chosen.