Episodic Billing Workflow

This quick reference guide provides the overall workflow steps required to complete episodic billing.

Step

Action

1.

Submit RAP

  • From the Episodic Console, look for records with 10 out of 10, or 11 out of 11 items completed.

  • Click the completed record to select and click Generate.

  • RAP moves to Agency > Billing > Episodic tab.

2.

Submit Claim

  • Go to Agency > Billing > Episodic.

  • Select the claim.

    Note

    RAP or Final Claims ready for submission are marked with a green check mark.

  • Hover over Actions and select Submit Claims.

  • Claims move to Agency > Billing > Pending.

3.

Internal Claim Quality Check

  • System checks claims in Pending queue for accuracy every 30 minutes.

  • Passed system checks claims move to Agency > Billing > Download Claim Files.

  • Claims that do not pass accuracy checks move to Agency > Billing > Rejected Claims.

    Note

    Rejected claims within the internal quality check are not rejected by the payer.

4.

Forward Claim to Payer

  • Download claim file to computer from Agency > Billing > Download Claims file tab.

  • Upload claim file to payer according to payer procedures.

5.

Review Rejected Claims

  • Claims that do not pass quality checks are located in Agency > Billing > Rejected Claims.

  • Rejection reason is listed in the Rejected queue.

  • Review claim using View tools: View Charges, View Claim, Resubmit Claim, and Move to New/Episodic.