New Claims Feature Update: How to Lock Claims Pile - Curacel

New Claims Feature Update: How to Lock Claims Pile

June 22, 2021
Author: samson

What’s New?

Hey Everbody! Thanks for reading the Weekly Feature Releases!

Below are the highlights:

  • As a Provider, you can not create a new pile for any month that is behind the claim submission cut-off date.
  • After an HMO uploads a bulk claim, if there are rejected items, the HMO will be able to view the details.
  • An HMO user with the user role of an ‘Auditor’, no longer have access to see or view ‘claims awaiting vetting’.

More about the ‘Claims Lock’!

As a Provider, It is now impossible to create a new pile for any month that’s behind the claim submission cut off date. This feature will only come into effect if an HMO has a specified cut-off date.

For the HMO, this now allows you to control the date criteria for batching claims into piles. This feature will improve your claims processing:

  • When a Provider tries to submit a claim that is ‘encounter date/month’ is past the cut off date set by an HMO, there will be an alert that notifies the Provider that the claim will be submitted into the ‘open month’, which is most likely the recent month. For example; a March encountered claim cannot be submitted into the March pile if the lock is set for June. It will be submitted into the June pile.
  • This allows you, an HMO, to have control when processing claims. It prevents the usually ‘claims submitted oversight’ that is usually carried over.

Hello HMO, to have this setting enables, follow the steps below:

  • Go to settings
  • Go to claim settings
  • Enable monthly submission deadline
  • Click ‘SAVE’
  • And that’s it!

WATCH HOW-TO SET A MONTHLY SUBMISSION DEADLINE FOR A PILE

Hello HMO, to have a lock on a claims pile by printing it:

  • Go to claims
  • Select the month
  • Select the provider
  • Click on ‘PRINT’
  • You will see a lock icon by the side of the STATUS
  • And that’s it!
HOW TO PRINT A PILE
PRINTED PILE (NOTICE THE KEY LOCK BY THE STATUS)

There’s more update.

  • An HMO should see a flag (green or orange) on any PA code. We’ve taken out the guess and hard work that has to do with verifying PA Codes. An HMO is now able to see a flag on a PA code to know if the PA Code is on the system or not.

An HMO user looking at a single claim that has a PA code should be able to tell if this PA code exists on the curacel platform or not. There should be a small flag icon beside the PA Code displayed.

If the PA Code exists on the platform for the Provider who submitted the claim, a green checkmark with a notification – ‘PA code exists’.

Otherwise, an orange warning icon with the notification – ‘Could not find this PA Code’.

See the image below to see how it looks:

  • HMO can now see the details of rejected items of a claim bulk upload by clicking the view button on the list. This is an improvement on the ‘Claims Bulk Upload feature. After uploading a bulk claims file, and the upload was successful, you should see a button – ‘view’. The view link is only visible when the status is ‘Review Required’. Clicking the ‘view button lets you see details of the rejected items.

Nobody likes bug. We don’t either.

  • When our users reported that the ‘Pay Advice’ email sent by an HMO to a Provider doesn’t have the PDF attachment in the email, we listened. It is now fixed! When an HMO click on ‘Pay Advice’, they can now ‘send PDF’ to the Provider and a copy is received by the HMO. You can go ahead and try it.
  • We have resolved the issue – “Next Pile assignment if previous piles are locked”. Once a pile is locked either by printing it or setting a submission deadline, a Provider can only submit a claim into the next open pile. How to print to Lock a Pile OR Set a Submission Deadline.
  • No more enrollee errors. There used to be an ‘error when an HMO user tries to search enrollee in CheckIn’. You can go ahead and search enrollees without any error.

If you’ve got any questions, simply reply to this email, book a call, or chat with us on WhatsApp and a Curacel team will get right back to you.