Billing

Aging

Balances owed by either insurance or patient that are due past 30 days.

Allowable Mismatch

A mismatch report to see whether or not the claims have been processed according to the contracted rates.

Autopost

A process that automatically posts payment EOBs received from the clearinghouse.

Batch Eligibility

Offered through these clearinghouse: Trizetto and Phicure. Batch eligibility works when a patient is scheduled 24 hours in advance, the clearinghouse will then send eligibility details. This will then run every 4 hours to provide any updated information.

Claim History

A documented history of the claim shows the status, timestamp, and user’s name. Users can also add comments/ notes about the claim.

Claim ID

A unique number generated whenever a claim is created in WRS. This will appear in Box 26 of the claim form as Account Number. This is used to search for the claim in WRS.

Claim Flag

The flag icon found in Create Claims page, once clicked will pull a note box that billers can use to communicate with the providers regarding the claim.

Clearinghouse

A service that checks insurance claims for errors. Clearinghouse electronically transmits claims to insurance carriers and also receives electronic remittance advice from the carriers.

Default Fee Schedule

A listing of the charges which the practice will bill on the claims for services based on CPT codes.

Electronic Funds Transfer (EFT)

An electronic method of transmitting money.

ERA

Electronic Remittance Advice. This is an electronic version of EOB. It gives details of insurance claim payments and adjustments

Miscellaneous Charges

Charges applied to the patient that does not involve a claim (e.g., no show fee)

Payer ID

A unique ID that is assigned to each insurance company. This ID is used for submitting claims electronically through our system.

Note: Payers can sometimes use different payer IDs depending on the clearinghouse they’re working with.

RVU

Relative Value Amount. An average amount that Medicare pays a provider for a treatment.

Self-Pay Claim

Claims created for services billed directly to the patient.

Taxonomy Code

These are codes used to indicate a provider’s field of specialty, at times required to process a claim.