Create Delinquent Insurance File

With the Create Delinquent Insurance File function, you can scan every patient account for procedures that have been submitted to insurance but the insurance has not responded within a user-specified time frame.

Upon accessing this function, you need to select the criteria you want to create delinquent insurance.

Data Field Information

Prompt	Response	Len
All or Select Groups	Select the option you want to use to create the delinquent insurance file.	1
Billing Group	If you chose to perform this function for a select Billing Group, type the code you want or click the magnifying glass to search the table.	3
Charges older than	Type the number of aging days, in increments of 15, for which you want insurance created. The age is determined by the date the claim was filed, not the accounting date.	3
Begin with Carrier	Type the code you want to start with, click the magnifying glass to search the table, or leave the field blank to start with the first code in the table.	5
End with Carrier	Type the code you want to end with, click the magnifying glass to search the table, or leave the field blank to end with the last code in the table.	5
Begin with Doctor	Type the code you want to start with, select from the Doctor code list, or leave the field blank to start with the first code in the table.	5
End with Doctor	Type the code you want to end with, select from the Doctor code list, or leave the field blank to end with the last code in the table.	5
Begin with Location	Type the code you want to start with, select from the Location code list, or leave the field blank to start with the first code in the table.	5
End with Location	Type the code you want to end with, select from the Location code list, or leave the field blank to end with the last code in the table.	5
Begin with Procedure	Type the code you want to start with, click the magnifying glass to search the table, or leave the field blank to start with the first code in the table.	5
End with Procedure	Type the code you want to end with, click the magnifying glass to search the table, or leave the field blank to end with the last code in the table.	5
Cycle Number	Type the code to indicate which delinquent claims you want to create. A = Create a delinquent claim for ALL charges that meet the parameters. 1 = Create a delinquent claim for any charge that has never had a delinquent claim created before. 2 = Create a delinquent claim for any charge that has had a delinquent claim created once before, and so on.	1
Electronic or Paper	Select the filing option you want. Even if you select the Electronic option, CGM webPRACTICE will file only the claims that can go electronically; the rest will go into the print file.	1
Suppress Pends	If you want to suppress all pended claims from being included in the delinquent insurance file, select this check box.	1

Data Field Information

Prompt	Response	Len
Insurance was last created through	This field is informational only and reflects the date that the insurance file was last created.	10
Delete previously printed paper file	If you want to delete the previously printed paper file, select this check box. If you select this check box, all claims that are in the paper claim file that have already been printed, will be deleted. If there are claims in the print file that have not been printed, they will not be deleted. This will not affect the electronic claims submission file.	1
Create through Date	Type the date you want or click the calendar icon to select a date. This date refers to the accounting date that the charges were posted with. No delinquent claim will be created for any charge with an accounting date after this date.	10

These criteria must be met in order for a procedure to be placed into the delinquent print file:

1) The billing group on the patient's account must match the billing group, if one was requested.

2) The procedure must still have a balance-due in the insurance balance. If the balance has been transferred to patient balance or adjusted off, this procedure will not be placed in the delinquent file.

3) If the procedure already exists in the delinquent file, it will not be created again until it is sent, printed, or otherwise removed from the file.

4) The policy effective date, termination date and the Bill this Carrier field in the patient's Insurance Policy Information screen are not checked. CGM webPRACTICE only looks at the patient's insurance ledger detail to determine if the procedure is delinquent. CGM webPRACTICE presumes that if the procedure is in the ledger, all parameters were met at the time of filing.

5) The filing date of the last time the claim was filed must be older than the number of days specified in the 'Charges older than' prompt to be included in the delinquent file.

6) The insurance carrier code on the original filing of this procedure must match the carrier code, if one was requested.

If the criteria listed above are satisfied, the procedure will be placed into the delinquent insurance file and will display with an asterisk (*) next to it in the Insurance Flag (I) column in the transaction history, indicating that it was automatically re-filed to insurance.

You may use the Delinquent File Inquiry function to determine when this create process is complete. It is important to print these claims when the create function is finished. If you let claims accumulate in this file prior to printing then you increase the likelihood that some of the claims might get processed in the meantime thus causing extra paperwork and denials.