When you create client notes, ICANotes+ automatically creates encounters in the Billing Worklist. After generating a claim, you can review and edit claim details before submitting the claim to the clearinghouse.

Editing a claim allows you to update billing information such as insurance details, diagnosis codes, service codes, provider information, and notes without changing the original encounter.

This article explains how to generate a claim, edit claim details, validate the claim, and submit it to the clearinghouse.

Billing Worklist tabs

The Billing Worklist contains the following tabs:

Claims

Use this tab to review, edit, generate, and prepare claims for submission.

Appointments Without Notes

Use this tab to review appointments that do not have associated notes.

This article explains how to edit claim details before submission from the Claims tab.

• Primary with Secondary and Tertiary: Select this option if the client has primary, secondary, and tertiary insurance policies added in the system.
• Primary with Secondary: Select this option if the client has primary and secondary insurance policies added in the system.
• Primary Only: Select this option if the client has only a primary insurance policy added in the system.
• Secondary with Primary: Select this option if the client has primary and secondary insurance policies added in the system and you are generating a claim for the secondary insurance payer.
• Tertiary with Secondary and Primary: Select this option if the client has primary, secondary, and tertiary insurance policies added in the system and you are generating a claim for the tertiary insurance payer.
• Tertiary Only: Select this option if the client has only a tertiary insurance policy added in the system.
  

Select the insurance option before clicking Generate. The selected option must match the client’s insurance policies and the payer for which the claim is being generated. Otherwise, claim generation may fail. Download the CSV file to review the validation error details.

1. Insurance Information
   
2. Diagnosis Codes
   
3. Service Codes
   
4. Rendering Provider
   
5. Service Facility
   
6. Billing Provider
   
7. Notes

Insurance Information

Select the Destination Payer (Primary, Secondary, or Tertiary).

Only the selected payer can be edited.

Primary destination payer

When Primary is selected:

• The Primary Insurance section is available for editing.
• You can change the payer or member ID.
• The Secondary Insurance and Tertiary Insurance sections are read-only.
• You can select the Secondary and Tertiary checkboxes to include those insurance details on the claim submitted to the primary payer.

Secondary destination payer

When Secondary is selected:

• The Secondary Insurance section is available for editing.
• You can change the payer or member ID.
• The Primary Insurance and Tertiary Insurance sections are read-only.
• You can select the Primary and Tertiary checkboxes to include those insurance details on the claim submitted to the secondary payer.

Tertiary destination payer

When Tertiary is selected:

• The Tertiary Insurance section is available for editing.
• You can change the payer or member ID.
• The Primary Insurance and Secondary Insurance sections are read-only.
• You can select the Primary and Secondary checkboxes to include those insurance details on the claim submitted to the tertiary payer.

Claim Frequency Code

Select one of the following values:

1. 1 – Original Claim
   
2. 7 – Replacement of Prior Claim
   
3. 8 – Void/Cancel of Prior Claim
   

Client Information

The following fields are read-only:

• Client Name
• Date of Birth (DOB)
• Gender

Diagnosis Codes

You can:

• Change an existing diagnosis code.
• Add diagnosis codes.

You can add up to 12 diagnosis codes.

Service Codes

You can update:

• Date of service
• Service codes
• Modifiers
• Units
• Billed amount
• Authorization details
• EPSDT option

You can also assign diagnosis pointers to the diagnosis codes associated with each service.

Rendering Provider

You can update:

• Rendering Provider
• NPI

Service Facility

You can update:

• Service Facility
• NPI

Billing Provider

You can update:

• Billing Provider
• NPI
• Tax ID type (EIN or SSN)
• Tax ID number

The billing provider address is read-only.

Notes

Save, validate, or submit a claim

After editing the claim, choose one of the following actions.

1. Save Claim for Later: Saves your changes so you can continue editing the claim later.
2. Validate Claim: Checks the claim for potential issues that could cause the payer to reject it. Correct any reported issues before submitting the claim.
3. Submit the Claim: Submits the claim to the clearinghouse for processing.

Validate a claim

Before submitting a claim, click Validate Claim to verify the claim details.

Validation identifies potential issues that could cause the payer to reject the claim. Review and correct any reported issues before submitting the claim.

Filter Claims Using Various Parameters

Use the available filters to narrow the claims displayed in the Claims worklist. You can filter claims by encounter details, client information, clinician, note details, insurance information, and claim submission status. After selecting the desired criteria, click Apply to refresh the results or Reset to clear all filters.

Claim Status Buckets

Billing Worklist includes status buckets in the Claims tab to help you quickly locate claims based on their current status and the action needed.

Each bucket displays the number of matching claims. Select a bucket to view claims with the corresponding statuses.

The available buckets are:

• Not Generated: Displays claims with the Not Generated status. Use this bucket to locate claims that need to be generated.
• Error: Displays claims with validation or submission failure statuses. Use this bucket to locate claims that require attention.
• Ready: Displays claims that are ready for submission or require resubmission.
• Billed: Displays claims that have been submitted or are awaiting a secondary or tertiary ERA.

Filters

1. Start Date: Select the earliest date to include claims in the results.
   
2. End Date: Select the latest date to include claims in the results.
3. Date Type: Choose which claim-related date the Start Date and End Date filters should apply to, such as the Encounter date, Not Crated, Last Signed.
4. Clients: Search for and select one or more clients to display claims associated with those clients only.
5. Location: Filter claims by one or more service locations.
6. Clinician: Filter claims by one or more rendering clinicians.
7. Provider Credentials: Display claims associated with the selected provider credential(s).
8. Signed By: Filter claims based on the signer of the associated clinical note.
9. Diagnosis Code: Display claims that contain the selected diagnosis code(s).
10. Service Codes: Display claims that include the selected service code(s).
11. Note Type: Filter claims by the type of clinical note associated with the encounter, Progress Note, Case Management, and so forth.
12. Note Status: Display claims associated with notes in the selected status (In Progress, Finished, Signed).
13. Exclude Non-Billable: Exclude encounters marked as non-billable from the results.
    
14. Exclude Self Pay: Exclude self-pay claims from the results. This filter is selected by default.
15. Telehealth Only: Display only claims associated with telehealth encounters.

eBilling / Insurance Filters

1. Payer: Search for and filter claims by one or more insurance payers. The filter supports multi-select and smart search.
   
2. Insurance Type: Filter claims by the selected insurance type.
3. Claim Status: Filter claims by one or more claim statuses to narrow the results. Claim statuses indicating validation or submission failures are displayed in red, making claims that require attention easier to identify.
4. Submission Status: Display claims based on their claim submission status, such as Not Submitted, Processing, Error, or Success.
5. Payer Ranking: Filter claims by the selected insurance level, such as Primary, Secondary, Tertiary, or Other.
6. Insurance Payments: Filter claims based on the insurance payment status. Options are: Insurance Paid, Insurance Not Paid, Insurance Balance Due, No Insurance Balance.
7. Has Secondary Insurance: Display only claims for clients who have secondary insurance on file.
8. Match ALL Selected Insurance Filters: When enabled, only claims that meet all selected eBilling/Insurance filter criteria are displayed. When disabled, claims matching any of the selected insurance filters are displayed.

Filter Actions

1. Apply: Applies the selected filters and refreshes the claims list.
2. Reset: Clears all selected filters and restores the default filter values.
   
3. Export CSV: Exports the filtered claims list to a CSV file based on the selected filters.

Edit Multiple Claims at One Time

You can edit multiple claims at one time by selecting the claims you want to edit and then selecting Edit Claims from the action bar at the bottom of the screen.

On the Edit Claim screen, use the Next and Previous arrow icons to move between the selected claims. Make the necessary changes to each claim before moving to the next one. After you finish editing all selected claims, validate the claims.

Claim Statuses

Each claim is assigned a status that reflects its current stage in the billing workflow. You can use the Claim Status filter to quickly locate claims that require attention, such as claims with validation or submission errors, and take the necessary action before resubmitting them.

Claim statuses indicating validation or submission failures are displayed in red, making claims that require attention easier to identify.

The following claim statuses are available:

1. Not Generated
2. Ready to Submit
3. Submitted
4. Marked as Billed
5. Submission in Progress
6. Validation Failed
7. Submission Failed
8. Awaiting Secondary ERA
9. Awaiting Tertiary ERA
10. Ready for Secondary
11. Ready for Secondary - Validation Failed
12. Ready for Secondary - Submission Failed
13. Ready for Tertiary
14. Ready for Tertiary - Validation Failed
15. Ready for Tertiary - Submission Failed

Claim statuses are grouped into the following status buckets.

Not Generated

The Not Generated bucket includes:

1. Not Generated

Error

The Error bucket includes:

1. Validation Failed
2. Submission Failed
3. Ready for Secondary - Validation Failed
4. Ready for Secondary - Submission Failed
5. Ready for Tertiary - Validation Failed
6. Ready for Tertiary - Submission Failed

Ready

The Ready bucket includes:

1. Ready to Submit
2. Ready for Secondary
3. Ready for Tertiary

Billed

The Billed bucket includes:

1. Submitted
2. Marked as Billed
3. Awaiting Secondary ERA
4. Awaiting Tertiary ERA

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