1. AWARDS
  2. Billing
  3. BillingBuilder

Working with Insurance Claims

Updated

Generating an 837 Claim File

To generate an 837 electronic claim file, complete the following steps:

    1. From the AWARDS Home screen, click Administration from the left-hand menu, and then click Fiscal.  The Fiscal fly-out menu is displayed.
    2. Click BillingBuilder.  The BillingBuilder Menu page is displayed.  
    3. Click Create Insurance Claims.  The Create Insurance Claims page is displayed.
    4. Click the Batch Number drop-down arrow and select the batch for which a claim file is to be generated.  

TIP: Please note, only invoice batches that have been posted to A/R are included in this drop-down. If you are an agency involved in payer testing, click the Test File checkbox (just below the Create 837 Claim File button) to insert a test indicator in the 837 claim file (ISA15).

    1. Click Create 837 Claim File.  The Create 837 Claim File page is displayed.  
    2. Click the Click here Claim File Download link, and then click Download to acknowledge the PHI Download Alert.  A txt formatted file is now downloaded to your computer.  This file is formatted correctly for submission to any payer that accepts a HIPAA-compliant electronic claim file. 
    3. The process of generating an 837 claim file is now complete.

Generating a HCFA Paper Claim Form

To generate a HCFA paper claim form, complete the following steps:

    1. From the AWARDS Home screen, click Administration from the left-hand menu, and then click Fiscal. The Fiscal fly-out menu is displayed.
    2. Click BillingBuilder.  The BillingBuilder Menu page is displayed.  
    3. Click Create Insurance Claims.  The Create Insurance Claim File page is displayed.
    4. Click the Batch Number drop-down arrow and select the batch for which a claim file is to be generated. 

  TIP: Note, only invoice batches that have been posted to A/R are included in this drop-down.

    1. Click HCFA-1500 Printable Form. The Data entry for HCFA-1500 printable form page is displayed. This page lists - in data entry mode - the HCFA-1500 forms for the invoices contained in the selected batch.
    1. Click HCFA-1500 printable form.  The Data entry for HCFA printable form page is displayed.  This page lists - in data entry mode - the HCFA forms for the invoices contained in the selected batch. 

  NOTE: One HCFA form is generated per invoice in the batch.  For example, if there are 30 invoices in the batch, 30 forms are displayed on this page. 

    1. Enter or update information on the forms as necessary.  AWARDS will have pre-populated the forms with any information available from the client's chart records, including the client's name, date of birth, gender, and insurance ID number.  The date of service, procedure code, diagnosis code, and rate for the procedure being billed will also have been filled in automatically.  

  NOTE: Any information manually entered on the HCFA-1500 form is NOT saved in AWARDS and will be removed once you navigate away from the page.

    1. At the bottom of the page, select the Data Only checkbox if you are using an actual CMS HCFA -1500 paper claim form when printing. A PDF is created that you can save to your computer from AWARDS.
    2. The process of generating a HCFA-1500 paper claim form is now complete.

 

Generating a UB-04 Paper Claim Form

To generate a UB-04 paper claim file, complete the following steps:

    1. From the AWARDS Home screen, click Administration from the left-hand menu, and then click Fiscal.  The Fiscal fly-out menu is displayed.
    2. Click BillingBuilder.  The BillingBuilder Menu page is displayed.
    3. Click Create Insurance Claims.  The Create Insurance Claim File page is displayed.
    4. Click the Batch Number drop-down arrow and select the batch for which a claim file is to be generated.  

  TIP: Please note, only invoice batches that have been posted to A/R are included in this drop-down.

    1. Click UB-04 Printable Form. The Data entry for UB-04 printable form page is displayed. This page lists - in data entry mode - the UB-04 forms for the invoices contained in the selected batch.

  NOTE: One UB-04 paper claim form is generated per invoice in the batch. For example, if there are 30 invoices in the batch, 30 forms are displayed on this page. However, this can be adjusted by using the Payers setting called Report Multiple Invoices on HCFA-1500 and UB-04 Per Consumer.

    1. Enter or update information on the forms as necessary. AWARDS will have pre-populated the forms with any information available from the client's chart records, including the client's name, date of birth, gender, and insurance ID number. The date of service, procedure code, diagnosis code, and rate for the procedure being billed will also have been filled in automatically.

  NOTE: Any information manually entered on the HFCA-1500 form is NOT saved in AWARDS and will be removed once you navigate away from page. 

    1. At the bottom of the page, select the Data Only checkbox if you are using an actual CMS UB-04 paper claim form when printing. This will just print the form data and not the form columns and labels.
    2. Once any needed updates are complete, click the UB-04 Printable Form button on the bottom of the page. A pdf is created that you can save to your computer from AWARDS.

  NOTE: Page breaks are automatically inserted between each invoice when printing. 

    1. The process of generating a UB-04 claim form is now complete.

Unposting an Invoice Batch

 WARNING! WARNING! Only invoice batches that do not have remittance information uploaded into AWARDS and/or payment and adjustments applied to invoices can be unposted.

To unpost an invoice batch, complete the following steps:

    1. From the AWARDS Home screen, from the left-hand menu click Administration, and then click Fiscal.  The Fiscal Reports Menu page is displayed.
    2. Click Billing BillingBuilder.  The BillingBuilder Menu page is displayed.
    3. Click Create Insurance Claims.  The Create Insurance Claim File page is displayed.
    4. Click the Batch Number drop-down arrow and select the batch to be unposted.

  TIP: Please note, only invoice batches that have been posted to A/R are included in this drop-down.

    1. Click UNPOST BATCH.  A confirmation page is displayed, confirming that the batch has been unposted.
    2. The process of unposting an invoice batch is now complete.
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