Filing claims with Apex. Please help!

[marsheye]

We have had both Crystal and Apex since October, but seem to be having difficulty filing claims quickly. Our insurance coordinator seems to be catching onto the new process, but I would love to hear how others are filing their claims.

She is printing out a daily schedule and going down the list and pulling up each invoice and looking through the record to make sure it is ready to be sent. Before sending the CMS 1500 to the Apex batch, she is scrubbing the claim manually to make sure everything works. I think if we eliminated that step, Apex would scrub for us much quicker.

I would love to hear the step by step process that other offices are using and how long it is taking you to get the claims from your system to Apex.

[mjhervey]

We've used Apex for over a year. I spoke with our insurance specialist, and I don't think Apex will scrub for you they tell you if a code is invalid or needs broken down more. We don't print schedules. Go to Reports/Claims report/choose date range/choose invoice status/Generate report. You can then filter the report by specific insurance ie: Medicare. No form means you haven't filed a claim yet. Apex is integrated in Crystal, we send our claims direct from the admin/eclaims tab. It's not perfect but we're happy overall. Hope this helps!!

[gracecrystalpm]

I did billing for our office before working for Crystal. Here are some of the tips I can give your biller.

1. I want to make sure everyone seen everyday to have an invoice (some won't apply like a contact lens check, quick follow up)
How to: go to schedule, pull up a day, check box display invoices.
What it does: show you an invoice # next to the patient name so you know an invoice has been created.

2. I want to make sure all claims have been filed or need to be filed online (like Eyemed, Superior..etc)
How to: Go to reports - Claims report - change type to display invoice status
What it does: It will show you all invoices with the claims status history -
no form - no CMS form was created
added to batch - claim has been added to batch but not submitted to clearing house
wrote to batch - claim has been submitted to clearing house
printed form - you printed this claim on paper

3. I keep up with all claims submitted to insurance, anything past 30 days is seriously past due in my personal opinion. (don't get me started on spectera claims)
How to: use insurance receivable report
What it does: I break it down by insurance and go oldest to newest. I run this report on a daily basis.

to submit claims:

1. you want to make sure your insurance companies have been set up properly - I'd highly recommend using check box automatically add to batch. 
How to: Admin - insurance - add this check box to all insurances you file to Apex
What it does: Once you create an invoice and assign the insurance to the invoice, a CMS form will automatically go to E-Claims as pending. Then your biller can go through the claims there. 

hope that helps.

Grace

[friscoeyeassociates]

Apex will scrub your CMS forms. It is one of the primary benefits of the service they provide. See the link for more information on exactly what they check for. www.apexedi.com/claim-scrubbing/

[jess]

In our office we do one of two things, either go to admin and e-claims and manually make sure claims are ready to be sent or we more recently since ICD-10 pull a claims report, invoice status and this allows us to double click on the patients name taking you directly to the billing page ( not need to individually search) the report will remain and open window making it easy to continue on down to the next one.  I personally click the button at the top to put them in order by insurance that why I remember to do the little things that are different for each insurance, if they are mixed I am bound to forget something. This report will reflect any patients seen that day with an invoice created.  We started doing this to help get used to the new DX codes as we can see the invoice the same time as the claim with out having to search every pt.  That way there is no guessing as to what DX code goes with the Special test since now I am able to see the description.  This has also helped us catch error faster for example if a doctor missed or added laterality we are noticing it and not just guessing or researching ever claim as if its wrong.

Now in the case that you maybe added a claim to batch from a different DOS, we still go to admin push all of our ready claims that we sent electronically to Apex over and then I put the remaining claims in order by updated dated and work any claims that are remaining.

Apex has been good for us, we use the anise format and that has also made a world of difference with our errors and mapping issues. The only trouble we have is sending secondary electronically we have to force them to fail in order to enter in any adjudication information