This article will cover workflows relevant to the documentation of insurance claims for your patients in Cerbo. If you are going to be filing claims with insurance companies please let us know at email@example.com, and we will activate the option for you to track patients' and insurance companies' financial responsibilities for rendered services. Without this option turned on, you will likely not have most of the features discussed below.
- Using the EDI Generator
- Generate Insurance Invoice
- Generate Insurance Invoice for Recurring Payments
If you are a Cerbo user and are filing claims with insurance companies, you likely fall in one of two categories:
- you send physical HCFA forms directly to the insurance company,
- you use the EDI generator; i.e. you digitally send claims information to the insurance company through a clearing house, or
- you work with a third-party biller who handles the paperwork.
The details of each workflow will be outlined below.
But first, before you can submit claims, ensure that service charges are correctly added to patient charts. This means properly documenting the service billing code, marking the service charge as insurance reimbursable (blue checkbox in image on left), and specifying the amount due from the patient, versus the amount due from the insurance company. In the "Notes about this charge" text box, you can record internal notes, e.g. how much is due as co-pay, whether this was marked as full insurance responsibility, etc.
If you are unsure about the amount due from each entity, you can assign the entire portion as insurance responsibility (see image on left). Once the insurance company has informed you of the amount they will reimburse, you can send an updated bill to the patient. More on this below.
If you are adding a charge with some co-pay and some insurance responsibility, you will see the charge broken up into two line-items representing the two amounts. See image on right for example
At any time, if you need a list of all pending insurance payments and/or patient co-pays, go to Reporting >> Insurance Payments. It will look similar to the image shown below.
Image above displays an instance of the Reporting >> Insurance Payments window
1. Generate HCFAs
This sub-section will go over how to generate HCFAs for practices that are mailing them to the relevant insurance companies.
If you're ready to generate and print HCFAs, go into the relevant note. Unless you're already in the note, the most efficient way of doing this for multiple patients would be to start from the window shown above (Reporting >> Insurance Payments). To go into a note requiring a HCFA, click on the encounter note date. If the note was signed, it will have both the date of service and date it was signed. Clicking on the date should bring up the note in a separate browser tab. From this window, with the note open, hover over Generate, and click on HCFA 1500 Claims Form (see image on right). This will generate the relevant form. Follow the instructions here to complete and print this. Once you're done with one, you can return to the already open "Insurance payments" screen and work on the next patient's HCFA.
2. EDI Generator - Send Claims Electronically
Manually generating HCFAs for each patient can be time intensive. An easier option is to use the Cerbo EDI generator. This is an option to generate digital (EDI) files that encapsulate relevant information for filing insurance claims. These EDI files are formatted such that you can transmit them through a third-party service that serves as a clearing house. For a complete description of how to use this feature, please refer to this article.
3. Generating Report for Use by Third-Party Biller
If you are contracting a third-party service to work with you to prepare insurance claims, the most efficient workflow is to generate a summary report of all patients who need to be billed through insurance. And send this to the biller. If needed, you can always set up the biller with a user profile so they may access these reports independently. When you're creating a user profile for billers, leave us a note in the "Notes to Cerbo" section of the Create New User window. This way we'll know not to charge for that user.
To generate the summary report for insurance payments, go to Reporting >> Financial Reports, and then click on "Insurance Billing Summary" as shown above.
From the subsequent (report preview) window, you can further filter the results to list patients who were seen within a specified date range and/or seen by specific providers. You can fax this report to your biller.
Updating Charts with Exact Insurance Payments
Once you have been reimbursed by the insurance company, you should ideally go back to the Insurance Payments window and edit each patient chart to reflect how much was ultimately covered by the insurance companies, how much is still owed, was written off, etc. To do so, navigate to Reporting >> Insurance Payments. Then click on the name of the charge (see image below). This will bring up the "Modify Existing Charge" window and you can specify the amount reimbursed, written off, and remaining as co-pay.
Insurance claims reimbursement third party biller EDI HCFA copay co-pay co pay patient responsibility insurance responsibility