HB Biller 101: Work Claims with Errors

Terminology and key concepts regarding claim processing, error codes, clearinghouse workflows, and attachment management from the HB Biller 101 course.

Claims Processing in Epic

Occurs automatically overnight after discharge/coding is complete, DNB errors are resolved, and the account is billed.

Claim Edits

Checks for inaccurate or missing information on claims that can be specific to a payer or an organization.

User Error

A type of claim edit that is fixed by you or other users.

Master File Error

A type of claim edit that is fixed by IT.

Error Code 100

The code assigned to the Registrar for Registration-related claim edits.

Error Code 200

The code assigned to the Biller for Billing-related claim edits.

Error Code 250

The code assigned to Revenue Integrity for Charging-related claim edits.

Error Code 300

The code assigned to the Coder for Coding-related claim edits.

Error Code 700

The code used for various users managing Attachments.

Error Code 800

The code assigned to the Transplant Biller/Coordinator for Transplant-related edits.

Claim Errors sidebar

The tool that guides users through fixing claim errors by providing instructions and possible fix links.

Refresh Claim

An action used to test a fix by re-checking the claim against edits; if successful, the error is no longer listed.

Occurrence Code 04

An occurrence code used in the training example for Vicky, which was required to be added to the account before submission.

Occurrence Code 11

A code indicating the onset of symptoms or illness date, required by insurance for physical therapy claims.

Correct (in Hosp Tx Inquiry)

The specific action chosen to add or remove a modifier when selecting a charge.

Attachment

Additional documentation, such as lab test results or emergency room notes, required by a payer for reimbursement.

Mark As Ready For Claims

The action taken to indicate manual review of an attachment is complete and the claim can be sent.

Clearinghouse

A system that scrubs claims for additional issues after they have passed Epic claim edits but before they reach payers for adjudication.

External Status Code

The text contained in a clearinghouse error message used to identify the specific issue returned to Epic.

Edit Claim Values (Edit Values)

A tool used for changes specific to a single claim that does not flow back upstream to registration or account charges.

Reset Claim

An action used to revert a claim to its original values after manual edits have been made.

Transfer

A manual action taken to move a claim to a different workqueue, often for review by a supervisor.

Liability Buckets

The location where users can view the Claim Status section to determine the reason for a payer rejection.

New and Updated Data

The option that must be set in the 'Process Claim With' field during resubmission to ensure a fix is included on the new claim.