Greenway Prime Suite can help your practice receive payments faster by helping you prioritize claims and make reporting easier, ultimately increasing your productivity. Below are a series of common questions about insurance claim functions in Prime Suite as answered by MDS Medical’s awesome Prime Suite revenue cycle management team!
Should I post a zero dollar payment from the Insurance EOB?
Yes! EOB (Explanation of Benefit) statements sometime include contractual amount, deductible, copay, or co-insurance, but not an amount paid.
- Navigate to A/R – Insurance Transactions. With the patient in view and the claims detail open, enter the check number and amount in the Insurance Transaction header. If there is a contractual amount, deductible, copay, or co-insurance, post the amount in the appropriate box, then enter 0.00 in the Amount box to the right. The status of each line item will reflect the balance pending; if the claim has been satisfied, this line will be marked with an F to indicate it is paid in full.
- On the right hand side of the line item, notice the double arrow icon with RC above it. Click on the arrows to find a list of Payment Reason Codes (PRC) and Adjustment Reason Codes that you can use to indicate the reason for the $0.00 payment, i.e. Deductible Amount. It is important to enter these codes, as they allow users to see the reason for the payment (or non-payment) in Prime Suite reports. To add a notation with any additional information on the line item, click the notepad icon to the right of the Payment Reason Codes arrows. This note will appear in patient statements and account information notes. Click Save at the bottom of the screen when you are finished posting.
- If you need to construct your own codes, they can be modified or added in the A/R – A/R Lookup Tables menu, in the Reporting Codes tab.
How should I post Rejections or Denials in Prime Suite?
If a claim is rejected or denied, it must reflect the status. With the help of Prime Suite reports, these statuses allow for review and analysis of all rejections/denials and allow for conversations to improve collection ratios.
Depending on your location in Prime Suite, there may be several ways to arrive at the claims rejection or denial screen (Claims Details). Below is one such method:
- Navigate to A/R – Claims Maintenance
- Using the available filters, find the claims you need to review. You can filter by patient ID, claim ID, or any other available option on the page. Click Search.
- Once you find your claim, highlight it and select View Details at the bottom of the page.
- When the page has finished loading, click the Actions tab. Select one of the boxes for Rejected or Denied. Click OK when finished and close the screen.
Once this is complete, the Insurance Transaction screen will reflect the changed status of the claim. To add a reason for the denial or rejection, select a Payment Reason Code from the available list for each line item or for the entire claim. This will ensure that your claims reports will reflect accurate information. If necessary, you can also add a notation into the notepad icons for further description
Is there a way for Prime Suite to attach modifiers I frequently use without having to always enter them on the charge entry screen?
Yes. The A/R – Procedures page allows users to attach modifiers to CPT codes and allows you to create Alternate CPT codes to create common CPT-modifier matches.
- Navigate to A/R – Procedures. In the white rectangle next to the globe, enter the CPT code you are seeking and click the Tab key to populate the code information.
- Once it populates, you can enter a modifier in the Modifiers boxes. Once you click Save the CPT code will always have these modifiers.
Note: It is considered a Best Practice to use Alternate CPT codes to create the CPT-Modifier match. This is suggested because a CPT-Modifier match for an E&M code (99213, for example) will always show on the charges page, and if the charge poster is not careful to notice, they can post a modifier without intending to do so.
To create an Alternate CPT code:
- Choose the master code to appear on the screen. Click the New Alt Code button. Click Yes to continue.
- Add a charge amount to the Procedure Charge section and a Local Description, then add the modifier to the Modifiers section.
- Save. The Alternate code will now be available for you to select on the Charges Page.
How do I follow up on claims?
Following up on claims is easy using the Claims Tracking report in Prime Suite. This report has a lot of helpful filter options, but they can get confusing. As a starting point, navigate to the report and use these simple filter descriptions to help you track your Claims appropriately:
- Access the report by navigating to Reporting – Report Selection – A/R Management – Claims Tracking Report
Use the filter options to find the claims data you need quickly:
- Report Type
- A Summary report type will provide the total number of claims, total charge amount, and total expected amount by Insurance Company
- A Detail report type will provide the information from the Summary, along with patient and Date of Service details.
- Group by
- Move the sections to group from left to right using the arrows. You can use up to 3 groupings. To see a broad picture of claims activity by payer, group by Insurance Company
- Choose a claims priority to narrow your search (Primary/Secondary/Tertiary/Independent) or use the All function to see all priorities
- Choose whether to see claims in all statuses or whether you only want to see certain statuses (i.e. Paid Partial, Paid in Full, etc).
- Aging Period
- Use this filter option to select specific aging periods, or days outstanding, of claims in the system.
- Run the Report: Once you have set your filters, use Immediate View or Background View options to see your report data. It is not recommended that this report be run in Immediate View during business hours.
I have a patient whose insurance ID was incorrect on their claims. I have corrected the problem, but how do I re-file all of the patient’s claims so that the new ID is added?
- Select the patient and navigate to Registration – Information. Correct the policy number information in the Insurance section at the bottom of the page and Save your work.
- Navigate to A/R – Claims Maintenance to find the patient’s listing of claims
- To see the patient’s listing of open claims to re-send, enter the patient ID in the appropriate field. Change the State of the claims to Open and click Search.
- The patient’s claims will appear. Click the Select All button to resend all claims, or choose specific claims by highlighting them.
- Click the Resend button at the bottom of the screen. The claims will be sent to the Claims Processing screen for submission to the Clearinghouse.