ITRANS PENDING CLAIMS MAILBOX

Transcription

1 ITRANS PENDING CLAIMS MAILBOX INSTRUCTIONS FOR EAGLESOFT USERS ON HOW TO RETRIEVE PENDING CLAIMS Updated: April 2013 OVERVIEW As of February 20 th, 2012, itrans began to send a message to Dental Offices when they send their electronic claims. The message indicates that there are pending items in the Office s Mailbox and prompts the user to retrieve them. Many offices are unaware of the existence of this mailbox and what it means to retrieve claims from it. This document will go through the procedure of how to retrieve claims in Eaglesoft, what to do with the items being retrieved and how to keep a clean and up to date Pending claims mailbox. WHAT IS THE MAILBOX? When itrans receives an electronic claim from a Dental Office, it must first go through itrans and then on to the Insurance Company. Upon receipt of the claim, itrans forwards the claim to the insurance company. itrans will wait 60 seconds for a response from the insurance and if they do not get a response, the transaction is considered pending. itrans will continue to attempt to send the claim until it receives a response from the insurance company. At this point the dental office will receive an Acknowledgement from itrans. This is not an EOB but just a notification of receipt. When the response is returned, it will be stored in the Pending Transactions area (or Mailbox), waiting for the Practice Management Software (like Eaglesoft) to retrieve them. WHAT DOES THIS MEAN FOR ME? This means that you did not receive an EOB or rejection response for the claim that you sent. The claim is likely showing now in the In Process Section of your Eaglesoft Claims or is showing in the itrans mailbox online. 1

2 NOTE: In Process claims require the Request For Outstanding transactions (ROT) process (otherwise known as the mailbox retrieval process) in order to retrieve responses and move it out of this window and into Open Status. WARNING: Many offices prefer to print the claim and get a patient signature rather than wait for a response from itrans. If you decide to mark the claim as submitted and thus move it to open status, the ROT process will return errors. (See section below Interpreting Claim Responses ) VIEWING YOUR MAILBOX 1. First, open your web browser and navigate to 2. Click on Login. 3. Select one of the certificates (it doesn t matter which one, as long as it is current and valid). 4. Once you have logged in you should see a navigation menu on the left hand side. 5. Click on Pending Transactions 6. Select the button Pending to Dental Office then click on Submit 2

3 7. The listing that you see is the mailbox to which itrans refers. 8. NOTE: Leave this page open for now, you may need to reference it later. 3

4 HOW TO RETRIEVE MAILBOX ITEMS (ROT REQUEST FOR OUTSTANDING TRANSACTIONS) 1. IMPORTANT: Before Proceeding with these instructions: If your office has any clients that use Pacific Blue Cross, go to the section below titled, Pacific Blue Cross and the Unsupported Transaction. NOTE: It is likely that claim rejections, Explanation of Benefits or other notifications will be sent to your printer. When you execute this process for the first time, there may be a large volume that prints out. If you do not want to have these items print out then before beginning the retrieval process, set your printer to offline. Then, delete all print jobs from that printer before setting it to online again. a. See section below titled: How to disable your printer 2. Go into Eaglesoft and open your claims window. 3. Select the check box for Unsubmitted Electronic claims only, do not check the other boxes. 4. Do not mark any of the claims you may have listed here. 5. Click the Process button 6. You will get a message: There are no electronic claims marked to submit. Would you like to check on any outstanding electronic claims at this time? Click on Yes. 4

5 7. From here you may encounter one of two things: a. You will be prompted to select a provider. (Go to step 8) 5

6 b. You will see a message that indicates that there are no pending claims to check at this time. (Go to Step 10) 6

7 CHOOSE A PROVIDER (FOR WHEN YOU HAVE ITEMS IN IN PROCESS) 8. If, after selecting Yes to the question of checking claims, you get a prompt to select a provider, go ahead and choose a dentist from the list provided and click on Use. It does not seem to matter which dentist is chosen so long as they have a valid digital certificate with itrans. 9. Next, you will be asked if you wish to send provider billing information. Select Yes. From here you should see the software process the claim responses. Go to the Next Section in this document entitled Interpreting Claim Responses. NO PENDING CLAIMS (FOR WHEN THERE ARE ITEMS ON ITRANS SITE) 10. If you encounter the message that there are no pending claims, and yet there are transactions listed on itrans site, then you may have to force the transactions to come down from itrans. 7

8 a. NOTE: Why do you sometimes get the no claims message? There seems to be a correlation between whether there are items in your In Process screen and this message. If you have nothing in your In Process window, then it s likely that you will get this message. 11. After clicking on OK to this message, you are taken back to the Process Insurance Claims screen. Click on Process again, and answer No to the prompt to check on outstanding claims. This will keep the CDA Electronic Claims window open. 12. Go back to the listing of pending claims on the itrans website. Pick one of the line items and make note of the Insurance Company and the Dentist listed for that claim. If you have closed your browser, go back to the section above, Viewing Your Mailbox, and follow the steps to access your pending claims. 8

9 13. Back in Eaglesoft, click on the Chk Pending Button in the CDA Electronic Claims window. 14. You will get a prompt to choose a carrier and when you click OK the Insurance Company list will open. 15. In the Insurance Company list, select the Insurance carrier that you made note of in step 12 click on Use. 9

10 16. Next you will get a prompt to select a provider. Click OK and the Provider/Staff window will open. 17. Select the provider that you made note of in step 12 click on Use. 18. Next, you will be asked if you wish to send provider billing information. Select Yes. From here you should see the software process the claim responses. Go to the Next Section in this document entitled Interpreting Claim Responses. INTERPRETING CLAIM RESPONSES At this point you should see the system begin to process the responses from pending claims. It will look the same as when you send a claim. The familiar file saved, waiting for carrier pickup and response message will appear. If this is the first time you have run the pending claims retrieval, it is possible to receive information from old claims that you have already addressed. 10

11 There are several different responses that you will see, some you may recognize and some that are unique. Following is an explanation of the responses you are likely to see: 1. Response received, but the Office Sequence number does not match any Office Sequence number in the Eaglesoft Database. a. This message means that a claim s status was changed in Eaglesoft. This can happen if you decide to mark a claim as submitted and move it from In Process or if the claim is closed and/or recreated. The sequence number that was attached to the claim is deleted and itrans can no longer make the correlation between the claim on their website and the claim in Eaglesoft. b. WARNING: Make note of when you see this message. Eaglesoft sometimes will re-create the claim that the message refers to. If this happens, simply close the claims that are created. For instructions on how to check for recreated claims, see section below How to Find Recreated Claims. 2. Claim was rejected. Please correct any errors before re-submitting. a. This message indicates that the Insurance Company has rejected the claim. The rejection will print out and provide further information. 3. Please process the secondary claim electronically. a. This message sometimes accompanies an EOB for the primary claim. At this point, the system populates the secondary claim with the primary information to use for co-ordination of benefits. b. NOTE: Most of the time, the secondary claim cannot be sent electronically despite this message. If the primary and secondary insurance company is the same, then co-ordination of benefits is usually possible electronically. Otherwise you will need to send the secondary claim through the mail. 11

12 4. Do you want to send provider billing information? a. You may encounter this message even after processing several claims. This message pertains to the insurance networks that use version 4 as they can use the billing information when receiving responses. b. Click on Yes and it will continue to process. 5. There are no additional outstanding transactions. a. When you see this message, you should be done. To verify, go back to the itrans site and check your pending transactions. If you already have the page open, refresh the page and allow it to resend information. You should see nothing listed in the pending transactions area. b. However, if you do see items still outstanding, make note of the date. It is possible that the transaction is too new and still has not received a response from the Insurance Company. c. NOTE: Sometimes this message does not come up at the end of the ROT process. If there is no feedback after 30 seconds then you can close the Claims window. d. You can also repeat the above process if you would like to make sure that all items are cleared. 12

13 PACIFIC BLUE CROSS AND THE UNSUPPORTED TRANSACTION Pacific Blue Cross is the one insurance company that we are aware of so far that cannot process pending claims. When attempting to retrieve claims from itrans, it was discovered that the process would get stuck on Pacific Blue Cross claims and would not finish processing as a result. To prevent this occurrence, follow these steps: 1. In Eaglesoft, go to Lists -> Insurance Companies 2. Select Pacific Blue Cross from the listing and click on Edit. 3. Click on the CDAnet Button in the Edit Insurance Company screen. 13

14 4. Uncheck the box for the Transaction Request for Pending Claims 5. Click Ok on the Insurance Carrier screen and on the Edit Insurance Company Screen. 14

15 6. Click Close on the Insurance Company listing. 7. Now you can run your pending claims processing. Go to the section above: How To Retrieve Mailbox Items. HOW TO DISABLE YOUR PRINTER 1. First open your printers window. a. In Windows XP go to Start Printers and Faxes b. In Windows 7 go to Start Devices and Printers 2. Select your printer and Right mouse click a. In Windows XP select Open b. In Windows 7 select See what s printing 3. Next click on the Printer Drop-down menu and click on Pause Printing. 15

16 After you have finished your Request for Outstanding Transactions: 4. Your printer queue will have a list of print jobs from the EOBs and rejections that were pushed through. 5. To remove them, first follow steps 1 and 2 above. 6. Next, click on the Printer Drop-down menu and click on Cancel All Documents 7. Then click on Pause Printing to remove the check mark. This will bring your printer back online. 16

17 HOW TO FIND RECREATED CLAIMS A common side effect of running the ROT is the recreation of certain claims that should be closed. This is especially notable when the Office Sequence Number error occurs though other messages can possibly recreate claims. 1. The best way to find recreated claims is to have a well-maintained Claims window to begin with. 2. All areas should be empty, with the exception of Open claims. 17

18 3. This way, it s easy to spot claims that were recreated after the ROT process. NOTE: If your claims window is not cleared out, it is highly recommended that you go through and process all of your claims. All Claims Should Be in Open Status. 4. Any re-created claims can be closed. a. Take note of Sec Elec. Claims as they will require the Primary to be closed first. Look for the primary under the Open claims section. 5. Another way to detect potentially recreated claims is to run your true date aging. To do this: a. In Eaglesoft, click on Activities and then Age Accounts NOTE: If your office does not age accounts on a daily basis, then this process can wait until you do run the aging whether it is at Month End or at Statement Creation. 18

19 b. Click ok to run the aging. c. At the end of the aging you may get an error that the system as detected a discrepancy. i. If you do not see an error, then your accounts are in balance and you are done with the ROT process. 19

20 6. To find and correct out of balance errors first go to Utilites System activity log. a. In here look for accounts listed by patient id and make note of them. 7. Next go to the patient s account. Right Mouse Click at the top of the account and select view claims for patient. 20

21 8. Look under each section (unsubmitted, unsubmitted electronic, In Process, Open) for outstanding claims and if they should not be open, go ahead and close them. 9. After going through each account in the System activity log, run true date aging again. This time it should not generate an error. 10. If any difficulties are encountered, contact Patterson Canada Support at MAILBOX MAINTENANCE Once you have cleared out the backlog of pending transactions, maintaining your mailbox should be a part of your daily and/or weekly processes. 1. As you send e-claims, you will still occasionally get the prompt to process pending claims in your mailbox. If you select Yes to the prompt, it will retrieve items and you will see responses like the ones outlined in the section above, Interpreting Claim Responses. There will be only a minimal number of claims that come through and allowing them to process can keep your patient accounts up to date. 2. Regardless of whether you select yes or no at the pending claims prompt, we recommend that you run the process outlined in this document at least Once a Day. 3. Should you have any questions regarding this document, please contact the Patterson Canada Technology Centre at and a Customer Representative will be happy to provide assistance. 21