E-Billing for Legacy Linked Contracts

On the Claim Adjustment window, if the Restrict Rebilling of Original Claims feature is enabled by the Payer, then only the Adjustment and Voidoptions are available from the Submission Type field. The Original option does not display. If the TRN is available in the TRN field, then Adjustment is selected by default in the Submission Type field; displayed as A in the Resubmit Claims page.

On the File Processing page under Admin > File Processing, the Batch Number search filter allows users to search for both batch and electronic claim numbers (CLM).

Providers with legacy Linked Contracts can rebill a claim without having to submit a request to the HHAeXchange Support Team; like the existing Rebill functionality for Internal Contracts. Under Billing > Electronic Billing, two menu items exist to support this feature: Batch Search (Linked) and Resubmit Claims (Linked).

Billing > Electronic Billing >Batch Search (Linked)/Resubmit Claims (Linked)

On the Resubmit Claims E-submission Batch screen, select the Payer from the Payer field to generate a new Batch Number.

The Office field is required based on the e-billing configuration. Once both fields are selected the Add Claims button is enabled. Click the Add Claims button to open the Claims Search page.

On the Claim Search screen, use the search filters to locate the claim. Searches can be generated by Batch Number, Invoice Number, Claim Status, Visit dates and Patient Name.

Search results are generated according to the selected search filters. From the search results, batch numbers can be selected using the checkboxes on the left-most column. Invoice Numbers are color-coded as a visual aid.

Click the Legend link on the right of the screen to view the various color definition.

The bottom of the search results page offers three action buttons: Select All & Add, Add, and Close.

Select	To...
Select All & Add	Save all records displayed on the page and include in the resubmit claim page.
Add	Save all selected records and include in the resubmit claim page.
Close	Close claim search popup and route back to the resubmit claim page.

On the Resubmit Claims page, Providers can edit or delete a record. Click the Pencil icon to access the Claim Adjustment screen. Click the Red X icon to remove an individual record from the claim resubmission.

On the Claim Adjustment screen, the Submission Type field is required marked with a red asterisk. There are three Submission Types: Original, Adjustment, and Void.

Select	To...
Original	Default option; used if the Provider does not edit the Submission Type. This option may be restricted by a Payer.
Adjustment	The TRN Number and Update TRN for fields populate if Adjustment is selected. For the TRN Number, indicate if this adjustment is for a Single Claim, All Claims with same Invoice Number, or All Selected Claims. Items such as Service Code, Pay Code, Rates, and Hours which appear below the line can only be adjusted as a Single Claim.
Void	In addition to the TRN Number and Update TRN for fields, the Place Updated Visit on Hold checkbox also becomes available. If selected, the required Manual Hold Reason field populates when selecting Void. Selecting Void hides other adjustment information fields on the window

Upon adjusting, click Save to update the selected record(s). Based on the selected Submission Type, respective TRN Number, and Update TRN for to the claim, selected records are updated accordingly.

If Single Claim is selected from the Update TRN for field, then only the current record for the selected Submission Type and TRN Number is updated. If Void is selected, then the visit can be placed on hold according to the chosen Manual Hold reason.

If the All Claims with same invoice number is selected from the Update TRN for field, then all matching records with the same Invoice Number are updated according to the chosen Submission Type and TRN Number. If Void is selected, then all records within the same Invoice Number can be placed on hold if/and according to the selected Manual Hold Reason.

If All Selected Claims is selected, then all records are updated with chosen Submission Type and TRN Number. If Void is selected, then all corresponding visits can be placed on hold if/and according to the selected Manual Hold Reason.

Click the Export and Download button to generate a Resubmit Export Claim. The system generates an 837 which is exported to the Payer and the user has the option to download the file to their local workstation. Once complete, the system routes back to the Batch Search page.

The system checks if the below-listed fields are changed on the adjustment screen. When processing Adjustments, the system updates invoice detail information with changed fields and marked at rebill invoice.

• Payroll Adj Hours

• Service Code

• Caregiver Pay Code

• Unit per Hours/Daily/Visit

Once a Claim is rebilled, a Y link appears under the Rebilled column. The image below illustrates search results by Invoice located under Billing > Invoice Search. Click the Y link to view the rebilling history for the Invoice.

The Re-Billed Details pop-up opens providing Invoice details.

Linked Providers can search for exported claims by going to Billing > Electronic Billing > Batch Search (Linked). The Payer and Claim Type fields are preselected to All by default. To narrow searches, select the applicable Payer(s) and Claim Type(s) as well as a date range.

Claim Types include: All, Original Claims, and Resubmit Claims.

The image below illustrates a search result according to the Resubmit Claims type.

Searches can also be generated by Payer and Claim Batch Number, as seen in the image below.

Click the Export link to download the exported batch or click the Batch Number link to open and view the batch details.

The Rebilling functionality is controlled by the Payer; therefore, the Payer must grant Providers permission.

Once the Payer grants permission, go to Admin > User Management > Edit Roles to enable the Resubmit Claims (Linked) and Batch Search (Linked) permissions under the Billing section for the options to be available to an assigned role.

Payers can remove the Original option from the Rebilling options on the Claims Adjustment under Billing > Electronic Billing > New Batch > Resubmit Claims (Linked). The Restrict Rebilling of Original Claims feature allows Payers to eliminate any duplicate claims that may be resubmitted. This feature is enabled and managed by the Payer.

When this feature is enabled, the Submission Type (ST) column in the Resubmit Claims page displays A for those claims that have been resubmitted as an Adjustment and have a TRN Number. Records without a TRN Number display blank.

Only claims with a TRN Number and Submission Type of Adjustment or Void can be downloaded and exported.