In PHI, invoices are the origination point for all billed events (i.e. insurance, non-insurance, and patient pay). Depending on how event(s) are billed, claims may be grouped together (same patient and bill source) in a single invoice.
The Invoices page is where you will find all invoice information and “Next Action Steps” such as transferring, rebilling, and the ability to view or print invoices and statements by date range.
1. To access the “Invoices” page, CLICK the Practice Icon, and CLICK “Invoices” under the Billing heading.
2. Invoices can be searched individually by invoice or claim number, or by date range. ENTER in the service date range you would like to search. You may also search by Invoice Date, Patient, or Billing Source, then CLICK “Get Results”.
Invoices can also be filtered down to show only those in patient due.
3. To open the Invoice for viewing/taking action, CLICK on the invoice number.
4. The invoice will open to the “Invoice Billing Activity” tab. This tab shows the service lines that are associated with the billed events contained in this invoice.
By default, the most current service lines will be displayed. To view previous billing activity, such as an original claim or previous rebills, CLICK the filter field and uncheck “Hide History Details.”
To view the following: Patient policies and auths, claim information, events, history of all the actions taken, outstanding balances etc. CLICK the discovery button of the service line.
At the bottom of the discovery page is where you can ENTER A/R Notes and Payment Notes. Both of these note types are visible on the A/R Summary Report and Extract.
5. From this tab the following actions can be taken (how-to steps further in this document):
- Transfer: To other insurance, non-insurance, or patient pay
- Rebill: Mark for Rebill or Edit and Rebill
- Change Status: Put “on hold,” resume processing or mark “Reopened”
- View: View paper claim file
- Undo: Undo a transfer to non-insurance or patient pay
- Add: Create a payment, adjustment, or recoupment with the selected service lines prepopulated for you
To Rebill a claim:
Note: In order to rebill a claim that has a payment or adjustment posted, those postings will need to be backed out (negative payment/adjustment) before the claim can be rebilled. (Steps on how to do this are further in this document)
1. SELECT the service line that you want to rebill. Note: Rebilling a single line from a claim will rebill ALL lines on the claim.
2. Next, CLICK on the Rebill button. From here, there will be two options: “Mark
for Rebill” and “Edit and Rebill”. “Mark for rebill” means sending the
the document out as is and “Edit and Rebill” allows you to edit portions of the
claim before sending it back out.
3. To edit the claim, CLICK “Edit and Rebill” and a window will appear in
which you may edit any fields except for the patient and employee names.
4. If you are rebilling with no changes, SELECT “Mark for Rebill”. There are three rebill types:
- Corrected: If the payor denied the claim, or a corrected claim is needed to replace an existing claim, ENTER the “Payor Control Number” that is found on the EOB. If a specific control number is not given, ENTER the payor’s claim number.
- Original: If for any reason, the claim doesn’t make it on-file with the payor (e.g. front end rejections), you should rebill as an original claim.
- Voided: A voided claim deletes a claim on the payors side. ENTER the “Payor Control Number” that is found on the EOB. If a specific control number is not given, ENTER the payor’s claim number. NOTE: You typically will only void a claim when the payor requests it.
To transfer a claim to another billing source:
- SELECT the line associated with the bill code that you want to transfer. You can only transfer one service line at a time.
2. CLICK “Transfer” and SELECT “Transfer to Other Insurance” or “Transfer to Non-Insurance.”
3. A pop up will appear. First, SELECT the billing source you want to transfer the claim to. Then, select the transfer type, (electronic or paper) and the appropriate authorization.
NOTE: There may be information pre-populated in this window. This information reflects payments previously posted in the system. Please ensure that all information (fields) is accurate prior to submitting the transfer. Information entered by the user during transfer does not post back into the system, it is only sent out on the claim.
4. Next, ENTER the Adjudication Date (payment date) found on the EOB. If payments have not been previously posted, enter the payment amount in the section circled below. Entering adjustments and patient responsibility amounts will be covered in the next step. Previously posted payments and adjustments will show as totals in the fields next to Payment Amount. Although optional, PHI recommends you enter in the Payor Control Number from the primary EOB.
5. Under the next heading, “Line Information” the “Transfer Amount” needs to match all amounts under the “Patient Responsibility” Group Code.
6. The “Reason Codes” are listed for review. If not pre-populated and you are unsure of which code you should use, look at the last page of your EOB where there is a legend/description of the reason codes.
7. When all information is entered correctly, SELECT .
To Transfer to Patient:
1. SELECT the service line and CLICK on “Transfer,” then “Transfer to Patient Pay.” ENTER in the amount to transfer. CLICK to uncheck “Mark as Insurance Paid” if you do not want to close the service line. Marking it as paid will post an adjustment to take the outstanding amount for the billing source to $0.
To undo a transfer to patient pay or non-insurance:
1. SELECT the patient pay or non-insurance service line. Then CLICK on “Undo” and select the appropriate option.
To View a paper claim:
1. CLICK on a service line of a claim that was billed as paper. Electronic claims cannot be viewed as a CMS1500 unless rebilled as paper.
To create a payment/adjustment/recoupment:
1. SELECT the desired service line(s) to be included. CLICK “Add” and choose payment, adjustment, or recoupment.
NOTE: These shortcuts function similarly to creating a payment, adjustment, or recoupment from the payments screen. The selected service lines will be pre-populated in the created payment. Please refer to the Payments section further down in this document for the step-by-step to post the payment/adjustment/recoupment.
Invoice Charges Tab:
1. CLICK on the “Invoice Charges” tab to view a list of billable events included in this invoice. CLICK on the green “Discovery” icon for the details of each event.
2. Events billed to non-insurance or patient pay can be returned to the Bill Events screen. SELECT the events and CLICK “Status,” then “Revert to Ready to Bill Status.” This will remove the event(s) from the invoice.
The “Details” tab shows an overview of the invoice.
Proprietary & Confidential