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ID	Title	Module	Category
88	Setting Up Electronic Claims and ERAs Setting Up Electronic Claims and ERAs BillPro submits your claims electronically and brings the payers' remittances back in. Both halves are enrolments handled through a clearinghouse, and neither happens the day you ask for it - so start earlier than feels necessary. How it fits together OfficePro builds the claim, the clearinghouse delivers it to the payer, and the payer sends back an electronic remittance advice - an ERA - saying what it paid and what it did not. The BillPro Account Center describes this as BillPro - Electronic Claims Submission, Powered by ClaimMD. Enrol each tax ID Enrolment is per business entity, not per practice. BillPro Enrolled Businesses : lists your Enrolled Entities with an Account #, Group and TaxID. If you bill under more than one tax ID - a second location, a separate professional corporation - each needs its own enrolment. Claims for an unenrolled tax ID have nowhere to go. Enrol for ERAs separately This is the step people miss. Being able to send claims does not mean you will receive remittances. ERA enrolment is a separate agreement with each payer, and the big payers are the slow ones - allow weeks, not days. Until a payer's ERA enrolment completes, its payments arrive as paper cheques and have to be posted by hand. That is workable, but it is not what you are paying for, so track which payers are done. Enrolment forms are generated from OfficePro - the Claim Enrollment Link under Connecting to ClaimMD produces the link to complete. Check your billing details before the first claim These appear on every claim and a mistake in them rejects everything at once rather than one claim at a time: The billing entity's name, pay-to address and group NPI. The tax ID, which must match the enrolment exactly. Each provider's individual NPI and taxonomy. Payer IDs for the insurers you actually bill. Send one real claim to one payer and follow it all the way to an ERA before you switch the practice over. A test of the whole path is worth more than checking each setting twice. Where you will work day to day The BillPro Billing Center is the hub. From there: Check ERAs pulls in new remittances - the number beside it is how many are waiting. Process Payer Payment posts a payment that did not arrive as an ERA. BillPro Account Settings is enrolment and entity details. BillPro Processing Reports is what the clearinghouse sent back about your submissions. Manual Cases, with Show Complete and Show Incomplete, is for claims built by hand rather than from a visit.
91	Questions About Claims and ERAs Questions About Claims and ERAs Does Accepted mean we have been paid? No. It means the payer took the claim in for processing. Payment is a separate event, and an accepted claim can still be denied. Claim Balance is what tells you where the money stands. What does Processing cover? Everything that is neither accepted nor rejected - including claims that have never been sent. If something has been in Processing for weeks, check first that it was actually submitted. Why does a claim disappear from the aged views? Those views only list claims with a balance outstanding, so a claim paid in full drops out. Clear the age filter or search for it directly. Is the claim age counted from the visit? No, from the date the claim was submitted. A claim sent late looks young even when the date of service is months old. What is the difference between enrolling for claims and enrolling for ERAs? Sending claims and receiving remittances are separate agreements, and ERA enrolment is per payer. You can be submitting successfully for months and still get paper cheques from a payer whose ERA enrolment has not completed. Do we need to enrol each tax ID separately? Yes. Enrolment is per business entity - each appears under Enrolled Entities with its own Account # and TaxID. Claims for an unenrolled tax ID have nowhere to go. How often should we check for ERAs? Pick a regular day. Remittances wait until you fetch them, and unposted ERAs make every patient balance wrong in the meantime. What if the ERA total does not match the deposit? Stop and look before posting. Usually a second remittance belongs to the same cheque. The Check Number on each ERA is what ties them together. Can we post an ERA twice by accident? Processed remittances move to PROCESSED ERAs with a Processed On date, so you can see what has been done. ReProcess exists for fixing a posting that went wrong - it is not part of the routine. The insurer paid less than we billed. Is that a rejection? Usually not. Contractual adjustments are the difference between your fee and the contracted rate, and they show under Adjustments / Discounts. What remains after the payment and the adjustment is the patient's or the secondary insurer's. How do we bill the secondary insurer? Create SECONDARY Claim Document on the claim. It carries the primary's payment and adjustments across, which is what the secondary payer needs. A patient's details were wrong. Do we fix the claim or the patient? The patient. Then Re-Create Claim Document so the claim is rebuilt from the corrected record. Fixing only the claim leaves the next one to reject the same way. Every claim to one payer is rejecting. What now? Treat it as one problem, not many. A whole payer rejecting points at enrolment or the payer ID rather than the individual claims. What are Manual Cases? Claims built by hand rather than generated from a visit, listed under Manual Cases with Show Complete and Show Incomplete. Where do we see what the clearinghouse said about a submission? BillPro Processing Reports in the billing centre - that is the clearinghouse's response to your batches, as distinct from the payer's response to a claim.
89	Receiving and Posting ERAs Receiving and Posting ERAs An ERA is the payer's explanation of a payment: which claims it covers, what was allowed, what was adjusted and what is left. Posting it applies all of that to the right claims at once, which is the whole point of billing electronically. Bringing them in From the BillPro Billing Center, Check ERAs fetches whatever the clearinghouse is holding. The count beside it tells you how many are waiting, so an unchanging number means nothing new has arrived - not that something is broken. Do this on a regular day of the week. ERAs sit until you fetch them, and a fortnight of unposted remittances makes every patient balance you look at wrong. Reading the list New arrivals appear under ERAs Received, each showing: ERA ID - the reference to quote to the payer or to support. Payer and Provider Tax ID - who paid, and which of your entities. Check Number and Amount - what to match against the deposit in your bank. Paid On - the payer's payment date. Reconcile the Amount against the actual deposit before you post. A remittance total that does not match the money received is the one thing worth stopping for - it usually means a second ERA belongs to the same cheque. Posting Process applies one remittance: payments and adjustments land on the claims it names, and the claim balances move accordingly. Once posted it moves to PROCESSED ERAs with a Processed On date. Process ERAs does the same for the batch, which is what you will normally use. ReProcess runs a remittance that has already been processed again. Reach for it when a posting went wrong, not as a matter of routine. Checking the result Open a claim from the remittance and look at Claim Detail: Claim Total against Total Payments, split into Insurance Payments and Patient Payments. Adjustments / Discounts - contractual write-offs the payer applied. Claim Balance - what is genuinely still outstanding. Claim Balance is the number that matters. It is calculated from the claim's services and payments, and it is what the aged views work from. What is left after the insurer pays A balance remaining after an ERA is posted is usually the patient's - a deductible, co-insurance, or a non-covered service. It is not automatically a problem with the claim. If the balance belongs to a secondary insurer instead, use Create SECONDARY Claim Document on the claim. That produces a Secondary Claim Document carrying the primary's payment and adjustments, which is what a secondary payer needs to see. Payments that did not come as an ERA Paper cheques, and payers whose ERA enrolment has not completed, are posted with Process Payer Payment from the billing centre. The result is the same; you are keying what the ERA would have told us.
35	Encounter Billing Tab Overview Encounter Billing Tab Overview Here's a concise summary of the Encounter Billing tab process for creating an insurance claim using the OfficePro Suite: Accessing the Billing Tab: Click the letter [B] next to the visit from the schedule or patient detail page. Alternatively, open the Encounter window and select the Billing tab. Billing Case Details: View patient billing case details by clicking the blue information icon, which reveals details such as the named insured and referring provider. Perform billing actions like adding a claim, entering insurance payments, and editing case details. Creating a Claim: A list of services added to the encounter is displayed, including their CPT codes and diagnosis codes. Ensure each service has both a diagnosis code and a CPT code. Yellow alert symbols indicate missing information. Click the Edit link next to the alert symbol to modify codes. For convenience, you can apply the selected diagnosis code to all services on the visit. Check the services you want to include in the claim and click Create claim from visit. Viewing the Claim: After the claim is created, it will appear in the Encounter Billing window below the case details. Review claim details such as the claim number, total amount claimed, payment status, and duration since the claim was submitted. Open the PDF or text version of the claim document for review or manual submission. Additional Resources: For detailed information on insurance billing, refer to BillPro tutorials and Knowledge Base articles. For managing diagnosis codes, consult the Configuration video on Diagnosis Code Administration.
44	How to Edit and Resubmit an Insurance Claim How to Edit and Resubmit an Insurance Claim Editing and resubmitting an insurance claim is a straightforward process in OfficePro. Follow these steps to ensure your claim is accurate and submitted successfully. Step 1: Locate the Claim You can find the claim in OfficePro using one of the following methods: By Patient: Navigate to the Patients section. Find the patient who received the services. Open the patient detail page and click on the Billing tab. Look for the claim associated with the date of the visit. By Visit: Go to the Visits section. Open the visit that the claim was for. Click Edit, then click on the Encounter icon. In the Encounter window, navigate to the Billing tab to view the claim. Using BillPro: Open BillPro by selecting Tools > BillPro from the top menu. Find the claim in the list by either date or patient name. Step 2: Open the Claim Details Once you've located the claim, click the pencil icon next to it to open the Claim Details window. Step 3: Edit Claim Information Click on either the ID or CPT field to open the Edit Service window. Navigate to the Billing Details tab. Make Necessary Edits: Update the Dx codes or Modifiers fields based on the feedback received from the clearinghouse or insurance company. After making your changes, click Save Encounter Service. Step 4: Re-create and Resubmit the Claim After saving your changes, go back to the Claim Details window. Click Re-create Claim Document at the bottom of the Claim Details window. Once the claim document is re-created, click the Submit Claim button at the bottom of the claim details page. Conclusion By following these steps, you can efficiently edit and resubmit an insurance claim in OfficePro, ensuring that your claims are accurate and compliant with the requirements of the insurance companies. If you have any questions or encounter any issues during this process, feel free to reach out for further assistance!
90	A Claim Is Rejected or Stuck in Processing A Claim Is Rejected or Stuck in Processing Start on the claims list and set the status filter, which has three values: Processing, Rejected and Accepted. Every claim is in exactly one of them, so between the three you are seeing your whole book. What the three actually mean Accepted - the payer took the claim in. It does not mean paid. A claim can sit accepted for weeks and then pay nothing. Rejected - it came back. There will be a reason; see below. Processing - anything else, including claims that have not been sent yet. This is the bucket that hides problems, because "not sent at all" and "sent and awaiting a response" look the same here. A claim was rejected Open it. The rejection text is recorded on the claim, and it is specific - a payer will name the field it did not like. Read it before changing anything, because most rejections are one wrong value rather than a broken claim. The usual causes, roughly in order: Patient identifiers - name, date of birth or member ID not matching the payer's record. A middle initial or a maiden name is enough. Coverage - the policy was not active on the date of service. Missing prior authorisation - add it under Other Fields. Diagnosis and service mismatch - the codes do not support each other. Provider details - NPI or taxonomy wrong for that payer. Correct the underlying record rather than the claim where you can - a wrong member ID will reject the next claim too. Then use Re-Create Claim Document so the claim is rebuilt from the corrected data, and send it again. If every claim to one payer rejects the same way, stop fixing them one at a time. That is an enrolment or a payer ID problem, and it will keep happening. A claim has been Processing for weeks First check whether it was actually sent. A claim that was created and never submitted sits in Processing indefinitely and no one is waiting on it but you. Then use the age filter. Current is the first 30 days since submission; the older buckets are where genuine problems live. Anything past 30 days with a balance deserves a call to the payer - quote the claim and, if you have one, the ERA ID. Note the age is counted from the date the claim was sent, not the date of service. A claim submitted late looks young here even when the visit is months old. I cannot find a claim in any aged view The aged views only show claims with a balance outstanding. A claim paid in full drops out of all of them - so a claim that seems to have vanished has usually been settled. Clear the age filter, or search for it directly, before concluding anything is missing. The claims list is empty No records found nearly always means the filters, not the data. Status, age range and date range all apply at once, and Current plus a narrow date range excludes most of a practice's claims. Use Clear and start again with one filter. The insurer paid but the claim still shows a balance Check the ERA was posted. Money that arrived is not applied until the remittance is processed. Look at Adjustments / Discounts - a contractual write-off may not have been taken. The remainder may legitimately be the patient's, or the secondary insurer's. Judge the claim by Claim Balance on the claim itself. It is calculated from the services and the payments actually recorded, and it is what the aged views use. Nothing arrives when I check for ERAs Almost always ERA enrolment for that payer has not completed. Sending claims and receiving remittances are separate enrolments, and payers can take weeks over the second one. Until it is live, that payer's payments arrive on paper and are posted with Process Payer Payment. What to have ready before contacting support The claim, the payer, the date of service, the rejection text as written, and the ERA ID if a remittance is involved. The rejection text is the part that shortens the conversation most - a paraphrase usually loses the field name that identifies the cause.