Understanding the Download Claims Screen

The Download Claims area provides users with a way to view the status of claim files that have been submitted (from the Post Batches screen). After the files are returned from the designated MAC(Medicare Administrative Contractor), or clean claims are returned from firstREV (by clicking Get Clean Claims from firstRev) users can then retrieve the Medicare claim files or commercial claim files (e.g. 837I, 837P) and send them to the appropriate clearinghouse or directly to the payor. Part of this process will depend on the file transmission settings that are setup for each receiver ID record.

Learn more about how the software processes claims that are submitted through the billing process.

The Download Claims screen includes several filtering options to search for previously submitted claim files as well as several columns of data for each record. The layout of this screen contains the following:

●     Claim filtering options used to specify claims that are displayed in the grid:

o     Created From— Claims created before this date will not display in the grid. date

o     Created Thru— Claims created after this date will not display in the grid. date

o     View Files for the last— Display claims that were posted within a certain number of days. By default, this is set to "7 Days".

o     File Downloaded?— Display claims based on whether or not the corresponding file has been downloaded yet. Select "No" if you only want to view claim files that have not been downloaded. By default, this is set to "No".

o     File Type— Indicate a specific type of claim file to be included in the search results By default, this is set to "All".

o     NPI— Display claims associated with a specific NPI number. By default, this is set to "All".

o     999— Display claims that have either an "Accepted" or a "Rejected" status for a 999 file that is associated. By default, this is set to "All".

o     277— Display claims that have either an "Accepted" or a "Rejected" status for a 277 file that is associated with the claim.

●     Get Clean Claims from firstRev — This button allows users to retrieve validated claims from the firstREV interface. After claims are edited and successfully validated in firstREV, simply click    to retrieve the corresponding claims.  

●     Columns of data included in the display grid for each claim file:

o     Action

o     999— After the 999 file is returned from the agency's MAC, this column will display a status of either "Accepted" or "Rejected".

o     277— After the 277 file is returned from the agency's MAC, this column will display a status of either "Accepted" or "Rejected".

o     Office— The office number associated with the corresponding claim.

o     Payor— The name of the payor associated with the claim.

o     File Type— The type of claim file (e.g. 837I, 837P, 835).

o     Created Date— The date and time that the corresponding claim file was submitted in the Post Batches screen.

o     User ID— The user that posted the corresponding claim.

o     Download Date— The date the corresponding claim file was downloaded (if applicable).

o     Download User ID— The user that downloaded the corresponding claim file (if applicable).

o     Sent Date— If a Medicare claim is submitted from this screen, this column will display the date and time (24 hour format) that the claim was transmitted.

o     Sent User ID— If a Medicare claim is submitted from this screen, this column will display the name of the specific user that clicked Send.

o     Action— After a Medicare claim file has been sent, a "Resend" link will display in this column. Users can then click Resend to resubmit the claims to Medicare. This option will only be available for Medicare claims that has already been sent.
 

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