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annag
Canine III

Auditing past insurance claims

I don't believe there is, but I thought I'd check -- is there any way to run a report of previously submitted insurance claims once there's a return date on them? We have been finding ourselves needing to audit insurance reimbursement or insurance processing with particular payers and there only seems to be the Claim Submission Report to list open/pending claims, no easy way to identify claims submitted in the past.

Example: I need a list of any claims with dates of service from 1/1/18 to 6/1/18 with procedure code D9223, or I need a list of claims submitted in all of 2017 to BCBS, etc. 

This is a very common task we find ourselves needing to perform due to payer errors, so if not already possible we would love for it to be on a future update. I would imagine it would be VERY helpful as practices could track # of claims to certain payers, etc. Thanks!

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omsnashville
Premolar II

Re: Auditing past insurance claims

For the first type of request, I would probably just set those parameters in a Patient Demographic report (Report > Patient > Patient Demographic). It won't give you the specifics by insurance Plan, but it will by carrier. However, I suspect that report would be too overwhelming to run for "all of 2017 to BCBS".

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annag
Canine III

Re: Auditing past insurance claims

Yeah, that's what we've been doing. I'm looking for a report that has date of service, claim total, submitted date, etc. (somewhat similar to the Claim Submission Report) but to get at that info after the claim has returned you have to open every patient and create that info manually. 

Let's say all of one carrier's claims are processing out-of-network in error and you need to send the insurance company a list of claims that need to be reprocessed. Or you want to see how a certain carrier/payer reimbursed a certain code. For anything like that, I have to open hundreds of accounts one-by-one. 

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jpisariktnosi
Premolar I

Re: Auditing past insurance claims

We had to do the same thing you mention in your last paragraph. For BCBS, we were able to pull that kind of report from Availity, but that doesn't necessarily work for other insurances. Otherwise, I've also looked for a report that puts more of those parameters together, but you can't get ALL of that info on one report. The last time I tried to pull a specific code pmt amt per insurance, I think I got 2 different spreadsheets that didn't coordinate at all. It's very frustrating.

If you're looking at outside options for reports, I really don't recommend Practice Pilot, at least not for accounting/insurance things.. It's got a lot of great superficial information and really snazzy charts, but when you get into the meat of what it's showing you, it can only get as detailed as WinOMS lets it.

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