besa Health Help Center

Claims is how we get paid and keep the lights on. It is important that you properly submit claims for a few different reasons. One is that we want to get this money from the insurance as fast as possible. Another is that it is very easy to miss a possible CPT or billed quantity which increases the insurance's reimbursement for the visit. Lastly, we cannot get rejected claims. This will absolutely kill us and the insurance company will find any reason to reject a claim. Remember - details matter!

📚Resources Needed

🚀 Tips & Tricks

Search the Patients eligibility before submitting the claim. It will allow you to autopopulate all the Patient data.
We will be adding information to the following sections:
1. Insurance Company / Benefit Plan
2. Patient Information
3. Subscriber Information
4. Billing Provider information
5. Rendering Provider
6. Service Location Information
7. Claim Information
8. Diagnosis Codes
9. Lines
Work with 3 different windows at once
Once you figure out your workflow, don’t change it. Do the same thing every single time.
99204 and/or 99214 only will be around 80% of all CPT codes used in claims. Don’t forget your modifiers.
We should be submitting claims the same day that we saw the Patient. In the evening time after the provider finished the encounter notes.
Always check your work!

📘 Instructions

Make sure not to forget one of these steps.

Pull up the Patient Billing Page and look at what visits need claims submitted for that day.
Pull up the EHR Billing page and filter the results to the specific day you’re working on.
Before submitting a Claim, run an eligibility check for the Patient. This will help to streamline the Patient. Here’s the article that goes over eligibility checks for Anthem Patients.
To submit a Claim, you will click Claims & Payments > Claims & Encounters

⚠️It is best to have 3 windows open (One with each) and have the Availity window be in the middle.
From the Patient billing spreadsheet, click on the encounter number and open the link to access the encounter note.
You should now be able to see the encounter note with the dx codes there at the bottom of the canvas.
From the EHR Billing page, click on the action icon in the far right of the row and select Generate Claim.
The claim form will now open up and you can see some of the details related to the encounter. You can also add items which is what we will be doing.
On the Availity Claim page, enter the following:
1. Organization = Besa Health Yang P.C.
2. Claim Type = Professional Claim
3. Payer = Anthem
4. Responsibility Sequence = Primary
In Patient information:
1. If you recently searched for their eligibility, use the Select a Patient option.
2. If not, enter the complete Patient information
3. If they had a copay or deductible deposit, put the amount in Patient Amount Paid
In Subscriber Information:
1. Add the Group #
2. For Authorized Plan to Remit Payment to Provider? Select Y - Yes
For Billing Provider Information:
1. Add the provider that treated the Patient
2. Address = 2030 Main St
3. Remove the Provider first and last name and put besa Health in the Organization field.
In Add Rendering Provider:
1. Choose the provider that treated the Patient
In Service Location:
1. Add the provider that treated the Patient
2. Remove the provider name and put besa Health for Location Name
3. Address = 218 w 4th Street Santa Ana, CA 92701
In Claim Information:
1. Patient Control Number = Encounter #
2. Place of service = 10 - Telehealth provided in Patients home
  This is true always because right now we are only seeing Patients via telehealth. This is subject to change.
3. Frequency Type = Admit through discharge claim
4. Provider Accepts Assignment = A - Assigned
5. Release of Information = Y - Yes, provider has signed statement
6. Provider Signature on File = Yes
Add all the dx codes that you see in the encounter.
In Lines:
1. Service From Date = Date of encounter
2. Place of Service = 10
3. CPT = Varies. Almost always 99204 or 99214
  Make sure to keep an eye to see if there’s other services we can bill for. Example: if there is a Counseling dx code, that should always be a new line item with the dx code as a pointer, CPT=99401, Modifier=25.
4. Modifier = 95 (Because it is telehealth)
5. Diagnosis Pointer = Whatever pointer matches the treatment of what was done. A lot of times there will be multiple pointers and dx codes for the one 99204 CPT.
6. Charges = 215 (Depends on new or existing Patient)
7. Quantity = 1
8. Continue
Double check your work and click Submit!!!!
Download the claim and save it as the encounter number. Example: Encounter 00401
Upload the claim file to the Claim Submissions folder and copy the file link.
In the Patient billing spreadsheet, complete the row with the information you have from the claim. Add the following information:
1. Status = Submitted
2. Add Claim File Link
3. Submission Type = Electronic
4. Price
Go back to the EHR billing page and add the following information:
1. Upload Claim File
2. Submission Type = Electronic
3. Save
  
  ⚠️You will know it is submitted by, if you click on the action icon for the encounter row - you will no longer see the Generate Claim option.
Always double check to make sure everything is good. If it is, move on to the next!