Filing a Coded Claim

AngelTrack's postprocess workflow supports both in-house and outside billers. This help document is for in-house billers and for outside billers who choose to integrate (i.e. who choose to use AngelTrack remotely to perform billing on the customer's behalf).

If you are not yet familiar with the numbers 837P, 999, 277CA, and 835, or if you do not yet know how your billing software, your clearinghouse, and the insurance carriers all work together, then read the EDI Primer first.


Calls Must be Coded First

As we know, dispatches must first be coded before submission to the clearinghouse. Coding in AngelTrack is fast and easy, because many of the datafields are filled-in for you, but every field must be meticulously reviewed, as AngelTrack is not a CAC, and thus, cannot code a claim.

To learn more about coding, refer to the Coding Guide.


Gathering Claims into a Batch

From the Insurance Filing Queue, tick the ☑ checkboxes in the leftmost column of the grid, selecting items for inclusion in a claim batch. Your clearinghouse can handle batches containing a mixture of Medicare, Medicaid, and Private claims... but your batches will probably be easier to manage if they contain only a single type of carrier.

Once you've chosen the items for the batch, click "Batch the Checked Runs" from the "Bulk Operations" box. As you create each batch, AngelTrack automatically generate the necessary "Claim Filed" payment events.

The underlying dispatches will then exit the Insurance Filing Queue, moving to  Awaiting payment . Meanwhile, your web browser will be redirected to the Insurance Transmission Queue where you can see your new batch.

To learn more about 837P batches in AngelTrack, refer to the Managing 837P Claim Batches Guide.


Transmitting the Batch to the Clearinghouse

The Insurance Filing Queue produces batches of claims which are ready to go to your clearinghouse. Other billing queues can also create batches of claims.

After you create a batch, AngelTrack will redirect you to the Insurance Transmission Queue where you can see your new batch. Click the batch's ID to open the EDI Batch Edit page where you can view its contents, or cancel it.

If AngelTrack's clearinghouse uploader/downloader is active, then it will automatically transmit your batch to your clearinghouse -- normally within 60 seconds. When that happens, the batch will change from  Pending upload  to  Transmitted , and all included dispatches will then exit the Insurance Filing Queue / Insurance Exception Queue, allowing you to move on to the next trips that you intend to claim. The uploaded batch, meanwhile, awaits the return of an X12.999 acknowledgement from your clearinghouse, which, when it arrives, will automatically mark the batch as  Accepted  or  Rejected .

Whereas if you do not use the clearinghouse uploader/downloader, then refer to the Clearinghouse Manual EDI Upload/Download Guide to learn how to do this manually.

CMS-1500 / Paper claims

From the Insurance Transmission Queue you can download a claim batch as a PDF containing a set of CMS-1500 documents, one per claim. You can then mark the batch as "transmitted" in the usual way.

You can also download single CMS-1500 forms from the Insurance Filing Queue, as well as from billing queues. If you do so, and if you submit the 1500 to a carrier, then be sure to click the "Record Claim Filed Events" button, which tells AngelTrack that you've filed the claim.

To learn more, refer to the Filing a Paper Claim Guide.

Unsupported clearinghouse

If your clearinghouse rejects one of AngelTrack's 837P documents, then contact AngelTrack Support. Every clearinghouse has requirements for its 837Ps, and so every clearinghouse produces an "837P Companion Guide" detailing these requirements. If you provide that guide to AngelTrack Support, they will review it and give you a timeline for implementing it. That way you won't need to switch clearinghouses.


Processing the Clearinghouse's Reply

Your clearinghouse should reply with an X12.999 document, which is an electronic datafile that tells AngelTrack whether the batch of claims was accepted or rejected. If the batch was rejected, the datafile will include an explanation.

If active, AngelTrack's clearinghouse uploader/downloader will fetch these replies from your clearinghouse, and attempt to automatically import them. Whereas if you do not use the clearinghouse uploader/downloader, then refer to the Clearinghouse Manual EDI Upload/Download Guide to learn how to do this manually.

Upon import, a 999 will change the status of a claim batch from  Transmitted  to either  Accepted  or  Rejected .

999 rejections

If the 999 document is a rejection, then all of the claims in the batch will be marked "failed", and all of the dispatches in the batch will go back to the Insurance Filing Queue (or Insurance Exception Queue if that's where they were before) to be re-coded and re-batched.

In that event, the Coding page will have a "Last 999" tab that you can click to see why the batch was rejected.

To learn more, refer to the 837P Batch Management Guide - 999 Section.


Processing the Replies from the Carriers

The insurance carriers should reply with X12.277CA documents, which are electronic datafiles that tell AngelTrack which individual claims are accepted for adjudication versus which are rejected. Your clearinghouse will collect the 277CA documents from the carriers, and make them available to you for download.

If active, AngelTrack's clearinghouse uploader/downloader will fetch these replies from your clearinghouse, and attempt to automatically import them. Whereas if you do not use the clearinghouse uploader/downloader, then refer to the Clearinghouse Manual EDI Upload/Download Guide to learn how to do this manually.

AngelTrack will process each 277CA document looking for rejections. Any rejected claim will be marked as such*, and then its dispatch will go back to the Insurance Filing Queue (or Insurance Exception Queue if that's where it was before) to be corrected and re-batched. When that happens, the Coding page will have a "Last 277CA" tab which you can click to see the reason for rejection.

Rejections from carriers are common, and occur for all sorts of reasons including invalid patient ID number, invalid group number, invalid SSN or DOB, expired policy, invalid diagnosis codes, missing modifiers, etc. etc.

To learn more, refer to the 837P Batch Management Guide - 277CA Section.

*When a claim is rejected by the clearinghouse or by a carrier, the corresponding "Claim" payment event in AngelTrack will be marked "failed", and the relevant 999 or 277CA document will be attached to the payment event for review.


EOBs Will Arrive Later

About a week or two later, X12.835 EOBs will come back from the carriers, through your clearinghouse.

If active, AngelTrack's clearinghouse uploader/downloader will fetch these for you, depositing them into the "Incoming Replies" tab of the Insurance Transmission Queue. Whereas if you do not use the clearinghouse uploader/downloader, then refer to the Clearinghouse Manual EDI Upload/Download Guide to learn how to do this manually.

After downloaded, AngelTrack will automatically import some of them, but any EOB that contains denials or corrections or ambiguous information will be left to a biller to manually import. These EOBs will be marked  Pending manual import , and remain in the "Incoming Replies" tab until a biller imports them.

Incoming replies

To learn more, read the Importing EOBs guide.

Manual input of non-X12 EOBs

If your clearinghouse does not provide EOBs in X12.835 format, then you must manually read and record them in AngelTrack. Each claim line in the EOB should become a payment event which reflects the insurer's reply. These payment events then drive AngelTrack's postprocess workflow.



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