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Professional Claims


Axxess Hospice now enables users to bill professional (HCFA-1500) claims seamlessly. This functionality streamlines billing processes and increases reimbursement opportunities so organizations can optimize revenue and grow business.


To bill professional claims, users must have permission to view and edit claims and insurance/payer information.

Payer and Claim Permissions


To give a user permission to view and edit insurance/payer information, edit the user’s profile and navigate to the Permissions tab. In the Administration section, select View, Add and Edit next to the Insurance/Payers permission.


People tab ➜ People Center ➜ Edit ➜ Permissions tab ➜ Administration ➜ Insurance/Payers ➜ View/Add/Edit



To give a user permission to view and edit claims, navigate to the Billing section of permissions in the user’s profile and select View, Add, Edit, and E-Submission next to the Claims permission.


People tab ➜ People Center ➜ Edit ➜ Permissions tab ➜ Billing ➜ Claims ➜ View/Add/Edit/E-Submission



Once the appropriate permissions are selected, click Save to finish granting the permissions to the user.

Add Professional Bill Type


To bill professional claims, the insurance/payer must have the Professional (CMS-1500) bill type selected. To select this bill type, navigate to the Insurances/Payers list from the list menu in the top right corner of any screen.


If the insurance/payer has already been added to the system, select Edit under Actions to edit the payer. If the insurance/payer has not been added to the system, select Add Insurance/Payer.


➜ Insurances/Payers ➜ Edit or Add Insurance/Payer



In the Information section of the Insurance/Claim Details tab, select Professional (CMS-1500) under Bill Type. Click Save to save the bill type and other insurance/payer information.


Insurance/Payer Details tab ➜ Information section ➜ Bill Type ➜ Professional (CMS-1500) ➜ Save


Create a Professional Claim


To create a professional (CMS-1500) claim, navigate to the Claims page under the Billing tab and click New Claim. Enter the patient name, claim date range, payer and type of bill, and click Create.


Billing tab ➜ Claims ➜ New Claim ➜ Create



The following bill types can be selected under Type of Bill:


121 Original Claim – Home

 

127 Replacement Claim – Home

 

128 Void Claim – Home

 

311 Original Claim – Home

 

317 Replacement Claim – Skilled Nursing Facility 

 

318 Void Claim – Skilled Nursing Facility 

 

321 Original Claim – Nursing Facility

 

327 Replace Claim – Nursing Facility

 

328 Void Claim – Nursing Facility

 

341 Original Claim – Hospice

 

347 Replacement Claim – Hospice 

 

348 Void Claim – Hospice 

 

When creating a new claim, users can select Primary and Room & Board as needed under Payer Type.

Verify a Professional Claim


To verify a professional (CMS-1500) claim, locate the claim on the Claims screen and click Verify under Actions.


Though not required, visits and orders should be completed before a claim is verified. Green check marks in the Visits Completed and Orders Completed columns indicate completion of these items.


Billing tab ➜ Claims ➜ Verify under Actions


When the claim opens for verification, confirm that the following information is signed, dated and attached as needed:

  • NOE for new patients entered into DDE and accepted
  • Signed and dated orders, F2F and CTI
  • Completed visits

Once all necessary information is entered, click Verify to finish verifying the claim.


Submit a Professional Claim


Once verified, a green check mark appears in the Claim Verified column on the Claims screen. Click Submit to submit the claim to the patient’s payer.


The print and download icons enable users to print and download claims as documentation.



Updated on 8/14/2020