If an insurance company (payer) says that they never received your claim and Therabill is indicating that there was an acknowledgment, then the payer may ask for proof of timely filing. This article will go over the steps you should take.
Try to catch it before it happens
It is best to watch your filing cabinet to make sure your claims turn green. If the claim turns green, then an acknowledgement as been received. However, just because it turns green does not mean that the payer is not losing the claim. You should also be paying close attention to your claim aging report to verify that you are getting paid for everything.
For more information on properly tracking your claims, please see: Tracking Claims in Therabill.
Step 1: Check if Acknowledgement was Received
You will want to go to your filing cabinet and check to see if the claim has a green color code. If the color is green, then Therabill received a 999 acknowledgement file from the clearinghouse. If the color is blue, then Therabill has not yet received an acknowledgement. If the color is blue, then there is not a way to show timely filing. This is why you will want to check your filing cabinet regularly for claims that are staying blue (unacknowledged).
Step 2: Find out what the payer needs for proof of timely filing.
You will want to call the payer to find out what they need for proof of timely filing. Different payers will want different information for proof. You will want to know exactly what they need.
A letter from the clearinghouse
If they need a letter from the clearinghouse, then you will want to call the clearinghouse and ask them for proof of timely filing. To find out who the clearinghouse is, please see the section below labeled Getting Claim and Submission Information.
The clearinghouses that Therabill submits through along with their phone numbers are below. NOTE: The clearinghouse will require information in order to find your claim. Please see the section below labeled Getting Claim and Submission Information for help getting this information.
- Office Ally: Therabill's username at Office Ally is eiassistant. Click Here for Office Ally Contact Information.
- Availity: Therabill's customer ID at Availity is 28797. Click Here for Availity Contact Information.
- Post N Track: Please e-mail firstname.lastname@example.org. Therabill will have the submission and acknowledgement files.
- Therabill: Therabill does have clearinghouse capabilities. For those that go through Therabill, please contact Therabill for information.
Information about the submission
In general, you can get information about the submission from within Therabill (if an acknowledgement was received). Below is how to access various information.
- Put your mouse over Filing in the top navigation bar of Therabill and click on CMS-1500 in the drop down menu to get to your insurance claims filing cabinet.
- Find the claim within your filling cabinet (use the filters at the top of the filing cabinet to help find the claim).
- Click the tools icon associated with the claim and then in the menu that appears, click on View Status Messages.
You will now see a form as shown in the image to the right (note: some information such as claim ID's and date stamps has been blocked out of the image for privacy purposes). This shows you all of the status messages on this claim. The first status message labeled Passed initial error check, is usually from Therabill. This message is created at the time the claim is created within Therabill. The next message is usually going to be from the clearinghouse when they respond with an acknowledgement (999 file). Any following messages are going to be 277 messages from the payer.
Each message is labeled with a time stamp (the time stamp on the first message is the time stamp that the claim was originally submitted from within Therabill) and then the message that was received. Directly under the message is a link labeled View Details. You will usually want to click on the View Details link for the last message in the list. If you click that link, a text file will be created. Below is an explanation of that text file.
Therabill's Claim Message Format
Messages that come back from the payer are in a format called 277. This format is meant to be computer readable and can be very hard for a human to decipher. For that reason, Therabill stores it in our proprietary format. While this format is still not easy to read, it is much easier to read than a 277 file. It also gives more information. The text file is shown in the image to the right.
The information is held in what is referred to as an associative array. An associative array has a key and a value. In the image to the right, the key is the value between brackets and the value comes after the => pointer. For convenience, we have pointed to various information in the image to the right using colored arrows. An explanation of those items is as follows.
- CLEARINGHOUSE (green arrow): This indicates which clearinghouse the claim went through. (OA = Office Ally, AV = Availity, TB = Therabill, PT = Post N Track, JP = Jopari, EI = Early Intervention).
- CH_BATCH_NUM (blue arrow): This is for Availity only. This is the Availity ID for the batch of claims. This batch number can be used when calling Availity.
- CLAIM_ID (red arrow): For other clearinghouses, other than Availity (see CH_BATCH_NUM above), this is their claim ID. This is the ID that you will want to use when calling the clearinghouse.
- PAYER_REF (yellow arrow): This is not always present, as not all payers send back reference numbers. If this is present, then this is the reference number assigned by the payer (insurance company). This is sometimes useful when contacting the payer to reference the claim.
Calling the clearinghouse
The payer may require information from the clearinghouse. If this is the case, you may need to call the clearinghouse to get this information. When calling the clearinghouse, make sure you have their batch number (Availity) or claim ID (Office Ally) ready. Also, make sure you know Therabill's username / customer ID. For Availity, our customer ID is 28797 and for Office Ally, our username is eiassistant.