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A Day in the Life of a Biller

Overview

This article outlines Procentive's recommendations for going through the daily billing tasks in an efficient way. If you follow this order you will be able to submit billing, track payments, and follow up on any outstanding claims in a timely and accurate fashion.

Step 1:  Electronic Module

  • Confirm that each clearing house/payer report is being processed and claims have not been rejected.  
  • Check all batch reports that are older than 3 days.
  • Check the reviewed column once you have confirmed no rejection(s).

Where can we link to from here on how to do this? https://support.procentive.com/Draft...ctronic_Module

 Step 2: ERA Module

  • Review ERA's that have not yet been processed (processed checkbox), working from oldest to newest.
  • Click on the filename link to view the report from the payer.
  • When you are receiving Procentive claims (claim # begins with PR), select Payment Entry Mode to add the correct payment amount and allocate it appropriately. 

Note:  We suggest you familiarize yourself with these frequently used window, you will see links to them throughout the billing-related modules:

Additional learning material can be found in our ERA section.

Step 3: Payments Module 

Additional Resources:

Resend a Claim

Claim Data on the X12 Summary Report

Verifying Modifiers

Process an ERA to a Secondary Payer

Fill out COB (this is typically automated, however, at times manual adjustments made need to be made)

Send Replacement or Void Claims

Posting Takebacks

Posting Interest

 

Step 4: Collections Module

  • Check your outstanding invoices regularly. 
    • Suggestion: at least once a month.
    • Use the radio button, Date last submitted to payer, at the top to view the most current re-submissions. 

Step 5:  Time Module

Residential Billing (if applicable)

For residential claims, this step would only be done once or twice a month, depending on your billing cycle. 

  • Change the filter at the top to View: Residential
  • Open the residential calendar.
  • Change the applicable service lines to billable codes.

Step 6: Billing Module

  • Click Add to see what is in the billing queue.
  • Identify dates (to and from dates)
    • Leave the from date blank (so any "back-dated" service lines are pulled into the billing queue) 
    • Enter a to date of 3 business days prior (allowing your clinicians space to make corrections). 
  • Check for service lines that cannot be billed at this time.
    • Note telling you how many service lines cannot be billed with a click here link to view these.
  • Send claims.

Step 7: Once a month

Create Client Statements -  Report #3560
  • Run this once all of the above steps have been completed.
Run Batch Eligibility

The above is in an ideal situation in which one biller is completing all steps. If there are multiple  staff working on various steps please be sure all steps are being completed.

We need a link for Send Claims.

Should we add commissions

Running Short on Time?

If you would like to send out any new claims that are in your billing queue,  you can do Steps 5 & 6 above, then come back to checking Electronic Reports and allocating ERA's and Payments tomorrow.

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