Refile Insurance Claims

With the Refile Insurance Claims function you can refile a claim to an insurance carrier.

If you are refiling a claim:

The date of service must be within the insurance policy's effective and termination dates.
The Bill this Carrier field on the patient's Insurance Policy Information screen can affect the refiling of claims:
- If the 'Y' (Yes) option is selected, the claim will be stored in the electronic transmission or print file and an entry is made in the patient's Transaction History Detail screen with the date the claim was refiled, the carrier it was refiled to, the Refile reason, if one was entered, and the amount that was refiled. The Insurance Flag (I) column is marked with an asterisk (*) for the refiled procedures.
- If the 'N' (No) option is selected, the claim will not be refiled and no notation is made on the account. NOTE: If the Override Ins. Billing check box is selected in the Location Code Table for the procedure(s), then this will be overridden and the claim will be placed into the electronic transmission or print file and a notation will be made on the patient's Transaction History Detail screen.
- If the 'C' (Courtesy) option is selected, the claim will be stored in the print or electronic transmission file and the Transaction History Detail screen will not be marked, but the Insurance Flag (I) column on the patient's Transaction History screen will be marked with an asterisk (*) for the refiled procedures. Since courtesy billing does not store an entry on the Transaction History Detail screen, if you need a copy of a claim, go to Print Insurance Form on Demand to request a claim.
If the balance on this transaction is in the patient's balance, the balance will be moved back to the insurance balance based on the insurance liability at the time the charge was originally filed for the selected carrier.
If you are refiling one of the Special Procedure Codes, you must refile all of the procedures along with the special procedure code to ensure that the special procedure code is linked to a valid procedure and billed correctly.
Each time a charge is refiled, the aging is recalculated based on the refile date on the Aged Accounts Receivable for Insurance reports. But, the charges continue to age based on the accounting date on the standard Aged Accounts Receivable reports. NOTE: If you want to print a claim without refiling it or affecting the aging, use the Print Insurance Form on Demand function.

Upon accessing this function, you must first select the patient and then the Insurance Refile screen displays containing the patient's insurance carrier(s) on file. Select the insurance carrier that you want to refile the claim to by clicking anywhere in the row containing the insurance policy information.

After you select the carrier, the patient's Transaction History screen displays. Click the transaction you want to refile. NOTE: If you want to deny transactions on a particular case only, select that case from the Case list in the upper-right corner of the screen. The screen will refresh displaying only the transactions for the selected case.

After you select the transaction to refile, the detailed Insurance Refile screen displays containing the information for the selected transaction.

Data Field Information

Prompt	Response	Len
Procedure Code	This field is informational only and reflects the procedure code on the selected transaction.	10
Date of Service	This field is informational only and reflects the date of service of the selected transaction.	10
Diagnosis Codes	This field is informational only and reflects the diagnosis code(s) on the selected transaction.	27
Assignment	If you want to accept assignment on this claim select this check box.	1
Original Amount	This field is informational only and reflects the original charge amount on the selected transaction.	10
Unpaid Amount	This field is informational only and reflects the amount still unpaid on the selected transaction.	10
ICN Number	Type the ICN (Insurance Claim Number) associated with this charge. The field defaults with the existing ICN number entered on this charge through the Payment Entry Function, Post ERA File or the last refile. The ICN is sent on electronic claims only and is required if you select a Resubmission Code of 7 or 8, although you can enter an ICN without a Resubmission Code. In that case, it does not go on the claim, but it does get stored on the account. Not all carriers require a resubmission code and ICN so you should be sure of the carrier's requirements before submitting a claim with these codes. If an ICN is entered on the payment or on the claim in a refile function, the ICN displays in the following places on the patient's account: - On the Transaction History screen when you click the plus sign (+) next to the charge. The most recently used ICN displays. - In ICN field at the top section of the Transaction History Detail screen for the payment. The ICN entered with the original payment displays. - Next to the payment code in the payment section of the Transaction History Detail screen for the charge. The ICN entered with the original payment displays. - Next to the claim action in the insurance ledger portion of the Transaction History Detail screen for the charge. The ICN used with the refile function displays next to the refiled charge only if a Resubmission Code of 7 or 8 was used when the claim was refiled.	50
Refile Reason	Type the reason that you are refiling the claim. This appears in the insurance ledger section in the Action column of the refile entry on the patient's Transaction History Detail screen.	40
Delay Reason Code	To satisfy some carrier requirements or for your own record keeping purposes, select the Delay Reason from the Delay Reason Code list. The Delay Reason code displays on the Transaction History Detail screen next to 'Claim Delay'. This will be sent with the electronic claim, but will not print on a paper claim.	2
Resubmission Code	Select the resubmission code for this claim from the list. This information is sent on electronic claims only. Not all carriers require this and may reject claims that contain this information. Make sure you are aware of the carrier's requirements before including this on the refile. If you select a Resubmission Code of 7 or 8, the ICN Number is required. The Resubmission Code appears beneath the refiled item in the insurance ledger portion of the patient's Transaction History Detail screen for this charge.	1
Refile to Paper	If you want to store this refiled claim in the print file to be printed later, select this check box. Or, you can print it now by selecting the Print Now check box. NOTE: This will not work for UB forms. To print a refiled UB form, use the Print Insurance Forms function.	1
Print Now	If you want this claim to print now, rather than being stored in the print file, select this check box. You must also select the Refile to Paper check box. NOTE: This will not work for UB forms. To print a refiled UB form, you must print it from the Print Insurance Forms function.	1
Refile all Charges for this Accounting Date	If you want to refile all charges posted with this accounting date, select this check box.	1

If you refile one transaction, whether electronically or to paper, a message will display stating that the procedure has been refiled.

If you refile all charges for the accounting date, whether electronically or to paper, a message displays stating that all procedures for this accounting date have been refiled.

After you click Save, the screen returns to the Transaction History screen where you can select additional transactions to refile.

NOTE: If you selected the Print Now check box, you must click Cancel from the Transaction History screen to access the Printers dialog box. If you choose Print Here to print the claim to the screen, the print job minimizes down to the Status bar at the bottom of the screen, and you must select it from there.