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PDGM Billing Center


The PDGM Billing Center enables users to manage all billing processes from a central location, including 30-day RAP and Final claim creation, and non-payment RAP submission for a seamless transition to PDGM.


Billing Center

Access the Billing Center


To access the Billing Center, users must have the Access Billing Center permission enabled.

 


Users with this permission can navigate to the Billing Center under the Billing tab.

 

 

Benefits of the Billing Center

  • The Billing Center is a one-stop shop that houses a variety of claim statuses, claim types and payer types.
  • It offers a direct connection to access historical data of previously submitted claims through the Claims History button.
  • The Billing Center features a user-friendly format for ease of use.

 


Billing Center Functionality

  • Billers can manage all claims in one central location, rather than navigating between several windows to manage different payers.
  • The Billing Center enables users to view the Create PPS RAP, Create Finals, and Create Claims sub-menus under one window.
  • Users can filter by RAP, Final, or Managed Care claims.

 

 

  • A Claims History button is available so that users do not have to return to the main Billing menu to access historical data of previously submitted claims. The button takes users to the claims history corresponding to the selected payer type. For example, selecting RAP or Final and clicking Claims History will navigate to the Medicare/HMO history. Selecting Managed Care then Claims History will navigate to the Managed Care claims history.
  • The Billing Center displays claims in Created, Rejected, and Denied status.
  • Claims in Rejected/Denied status can be reviewed and addressed in one screen for the selected payer type.

 

 

The same functionalities available in the previous Billing menu are available in the Billing Center.

  • Users can filter by date range, payer, and patient status.
  • The Verified column displays verification checks to include all steps required for claim submission.

 

Pending Claims

The Pending Claims screen provides a centralized location for managing all Medicare and Managed Care claims that have outstanding balances. Unlike the previous Pending Claims window, the new page eliminates restrictions that occur when handling multiple payer types. It streamlines operations by consolidating multiple functionalities and optimizes ease of use by gathering all claims with remaining balances in to a ‘ready to work’ location. Agencies can establish a more seamless workflow with the ability to document check details, post payments, and adjust claims from the Pending Claims screen.


Benefits of Pending Claims

  • The Pending Claims window establishes a seamless workflow by enabling users to document check details, post payments, and make adjustments in one place.
  • It is essentially a workable Account Receivable window with an enhanced user experience.
  • In contrast to the previous Pending Claims window, the new page eliminates restrictions that occur when handling multiple Payer Types.


Access Pending Claims

The Pending Claims page is only accessible to users with the Access Billing Center permission.

 

 

To access the Pending Claims page, navigate to the Billing tab and select Pending Claims from the drop-down menu.

 


Functionality of Pending Claims


Refined New Filters

  • The ability to filter by date range, specific payers, and patients by status enables users to easily locate specific pending claims.
  • The Pending Claims page displays claims with the following criteria:

    • – Claims that have a remaining balance, either Negative or Positive
    – Claims that do not have the status Created or Reopened

  • Additionally, a filter to select either RAP, Final, or Managed Care is also available for users.

 

 

Sortable Columns

  • The data generated from the filters is displayed in table columns, which contain sorting capabilities.
  • The user can update receivables of claims with remaining balances.

 

Aging Metrics

  • An exciting new Aging Metrics feature enables filtering and gives users an at-a-glance view of aging claim buckets.
  • The metrics are calculated from the claim’s bill date to the current date.
  • Users can click on a specific bucket to filter down the list and view only claims within that corresponding age range.
  • The calculations are split into the following categories, which can be filtered by simply clicking on the color code:

    • o 0-7 days old
    o 8-30 days old
    o 31-60 days old
    o 61-90 days old
    o Over 90 days old

 


Edit Claim Information

  • Pending Claims creates ease of use by gathering all claims with a remaining balance to a centralized claim management window.
  • The Ready to Work claims with an outstanding balance can be viewed and addressed in one screen for all payer types.
  • The Edit button integrates both the claim posting and adjusting capabilities to easily update claim balances from a single screen.

 


   
  

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