Claim Manager

DuxWare Claim Manager

The DuxWare Claim Manager is where pending claims reside to be submitted to the respective payers either via Electronic or Paper submission.
The user may also:

• Retrieve and view previously submitted batches
  
• Mark previously filed batches back to pending
  
• Submit claims by provider, location, etc.
  
• Review claims pending by payer, held by payer, pending by batch, or held by batch
  

To access the Claim Manager, select Claim Manager from the Claims tab as illustrated below:

Once you have selected Claim Manager, you will land in the Claim Manager with the Summary Tab highlighted in yellow as illustrated below:

At this point, you have the option to select the appropriate 837 Setup to gather your electronic claims, print Claim Forms, or review claims that are:

• Pending by Payer
• Held by Payer
• Pending by Batch
• Held by Batch
• Select the Flag to the right of the Summary Tab to retrieve previous batches

We do ask that you call into our Customer Support Department to assist with configuring the ANSI Setups for your clearinghouse.

Gathering claims and submitting Electronically

Access the Claim Manager as illustrated above.

Select the appropriate 837 Setup. For this example, we will choose ANSI 837 5010P. This type setup is used for Professional claims such as would be
billed from a physician's office.

Once the 837 ANSI Setup is selected, you will land at the following screen, and a list of your open claims will populate the screen as illustrated below.
If you would like to see claim details, select the Expand button. Select Collapse button to collapse the claims. The Action button will give the options to:

• Create Batch
• Mark as Held
• Mark as Manual
• Close the Action window

In our example, there are 4 claims under the Error Claims tab that were separated from the open claims. You have the option to view the Error claims and resolve errors before you submit claims to the clearinghouse, or you can submit the Open claims now and correct the errors at a later time. As you resolve errors on claims, they will automatically move to under the Open Claims tab once you regather your claims under the ANSI setup.

You are now ready to log into your clearinghouse and upload your claims file. Your claim submission file will either have a file extension of .837 or .txt.

Mark Claims Back to Pending or Take other Actions with a Submission File

For instance, you may have submitted a test file to your respective clearinghouse. The clearinghouse may ask you to resubmit your submission file
in a new submission file. To accomplish that task, you would need to be able to Mark your previous submission back to Pending status.

Below are illustrations to help you through the process.

If you have any claims that have errors on them they will be in the Error Claims box click on the box to see these Claims choose Expand to see the error in the red bar at the top of the claim You can choose Edit Claim to make changes to the claim right here

You can send your open claims and come back to correct the Error Claims later if you wish

Held Claims These are Claims that you have put on hold. They are waiting for you to put them back to Pending or to Mark as Manual because you don't need to send them to the Payer or the Clearinghouse. Manual Claims Claims that you are not sending electronically – or at all.

Go back to Open Claims – you will notice that the claims are all marked Pending the next step is to Create a Batch Click on the Create Batch button a box will pop up select Create New Batch your new Batch has been created the Create Batch button has changed to Submit Claims Choose Submit Claims the Claim Submission box appears and immediately a second box will appear asking you to Open or Save File – choose Save File and click OK if a box comes up asking where to save the file choose Desktop this will save the file to your Desktop close the Claim Submission box

Now all the claims are marked Filed – you have created a batch and the file is on your Desktop

If there is a time when you need to get back to a previous batch to resend or put back to pending Click on the Flag in the top row Choose the file you would like to re-send because the Clearinghouse did not receive them for any reason. Click the Action button – a pop-up will appear select Mark as Pending. hit Yes when it asks you Are You Sure. now your claims are put back to Pending and you can create a new submissison file to re-send them.

When you submit the claims they will be Marked as Filed