How to Submit Claim to the Primary Payer
Overview
Prerequisites
Before submitting a claim, make sure the following requirements are met:
Subscribe to ICANotes+
You must have an active ICANotes+ subscription to submit claims through a clearinghouse.Set up the clearinghouse
Contact the ICANotes sales team to set up the clearinghouse for your practice. You must complete a training session with an ICANotes trainer before submitting claims.Add client insurance
The client's insurance information must be entered in ICANotes Plus.Enter mandatory claim details
Make sure all required information for claim submission is entered.Add the payer to the client's insurance
The payer to which you are submitting the claim must be configured in the client's insurance information.Verify your permissions
Your user role must have access to the Billing Worklist.
Subscribing to ICANotes+
You must have an active ICANotes+ subscription to submit claims through a clearinghouse.
Setting Up the Clearinghouse
After your ICANotes+ subscription is activated, contact the ICANotes sales team to set up the clearinghouse for your practice.
The sales team will assist you with the clearinghouse setup and arrange training on claim submission. You must complete a training session with an ICANotes trainer before submitting claims. The trainer will assist you with submitting your initial batch of claims.
Adding Client Insurance
Client insurance information must be entered in ICANotes before you generate a claim.
For more information, see Adding Client's Insurance Information.
Entering Mandatory Claim Details
Make sure all mandatory information required for claim submission is entered before generating the claim.
For more information about the required details and where to enter them, see Entering Mandatory Details for Successful Claim Submission.
Verifying Permissions
Only users with access to Billing Worklist can submit claims.
If you cannot access the Billing Worklist tab, contact your administrator to verify that you have the required permission.
The permission can be assigned from Settings > Roles and Permissions > Select a role > Dashboard > Access the Billing Worklist Dashboard.
Generating a Claim
When you create a note, the associated claim appears in the Claims tab with a status of Not Generated.
To generate a claim:
Go to Dashboard > Billing Worklist > Claims.
Select the Not Generated bucket.
Use the filters, if needed, to find the claim.
Select the claim you want to submit.
Select Generate Claims.
If all required claim information is available, the claim is generated successfully and moves to the Ready bucket.
If required information is missing or invalid, the claim status changes to Validation Failed and the claim moves to the Error bucket.
Reviewing and Fixing Claim Errors
If a claim moves to the Error bucket, review the errors and correct the required information before generating the claim again.
You can review claim errors in either of the following ways:
- Edit the claim and review the validation errors.
- Download the CSV file to review the validation error details.
Reviewing Errors in the Claim
To review and fix errors from the claim:
- Select the Error bucket.
- Select the claim.
- Select Edit Claim.
Review the errors and update the required information.
After fixing the errors:
- Go to the Not Generated bucket.
- Select the claim.
- Select Generate Claims.
If all required information is valid, the claim is generated successfully and moves to the Ready bucket.
Submitting the Claim
After the claim moves to the Ready bucket, you can submit it to the primary payer.
To submit the claim:
- In the Ready bucket, select the claim.
- Select Submit Claims.
Understanding Claim Statuses
Not Generated
The claim is available to be generated.
Validation Failed
The claim contains missing or invalid information and requires correction. After you fix the errors and generate the claim again, the claim moves to Ready.
Ready
The claim has been generated successfully and is ready to be submitted.
Billed
The claim has been successfully submitted.
FAQs
Why did my claim move to the Error bucket?
The claim moved to the Error bucket because required claim information is missing or invalid. Review the validation errors, correct the required information, and generate the claim again.
How can I review the errors for a claim?
You can select the claim from the Error bucket and select Edit Claim to review the errors. You can also download the CSV file to review the validation error details.
Where does a claim appear after it is generated successfully?
A successfully generated claim moves to the Ready bucket.
Where does a claim appear after it is submitted?
After the claim is successfully submitted, it moves to the Billed bucket.
How do I find a specific claim in the Not Generated bucket?
You can use the available filters to narrow down the claims displayed in the Not Generated bucket.
What happens if required information is missing when I generate a claim?
The claim status changes to Validation Failed, and the claim moves to the Error bucket.
What should I do after fixing the errors on a claim?
Go to the Not Generated bucket, select the claim, and select Generate again. If all required information is valid, the claim moves to the Ready bucket.
What happens after I submit a claim?
A message appears indicating that the claim will be processed and the status will be updated. After the claim is successfully submitted, it moves to the Billed bucket.
Where can I find information about the mandatory details required for claim submission?
See Entering Mandatory Details for Successful Claim Submission.
Where can I find information about adding a client's insurance?
See Adding Client's Insurance Information.
Need Help?
📞 Phone: 443-203-5857
📱 Text: 866-301-0085
📧 Email: ticket@icanotes.com
💬 Chat: https://app.icanotes.com