Overview
Claim preview files can be found in the 'Aging' module. This area will allow you to upload a claim preview file, initiate the auto-sync process, and provide a summary of the data processed in the file.
Upload and Process
Your claim previews are automatically imported daily (at 2:00 am CST) via the automated sync process. If you do not want to wait until the next automated sync, the process can be initiated manually using the ‘Auto-Sync Claim Preview' button. If needed, claim preview files can also be manually uploaded using the ‘Select & Upload A Claim Preview.’
Auto-Sync Claim Previews
The ‘Auto-Sync Claim Previews’ button can retrieve claim previews before the next automated sync. It will import the previews for claims from RevolutionEHR created the day before and today.
1. Select ‘Auto-Sync Claim Previews.’
2. Select the ‘Auto-Sync Claim Previews' button to initiate the process, or select ‘Cancel’ if you do not wish to proceed. The amount of time it takes to process the file will depend on the number of claims it contains.
3. When the process is finished, the modal will close, and a message will display, letting you know if the file was processed successfully or if there was an error.
4. The results will be displayed in the ‘Last Claim Preview File Uploaded & Processed’ and the ‘Recent Claim Preview File History’ sections. The 'Matched' and 'Unmatched' counts will continue to update. Navigate to a different screen and then navigate back to see the latest data.
Exporting a Claim Preview File from Revolution
Select ‘Learn about exporting files from RevolutionEHR’ and follow the instructions on how to export and download the claim preview file from RevolutionEHR.
Select & Upload a Claim Preview File
1. Select the ‘Select & Upload A Claim Preview File’ button.
2. Select the upload icon, then select the previously downloaded file.
3. Confirm the correct file was selected.
4. Select the ‘Upload & Process Claim Preview File’ button to initiate the upload process, or select ‘Cancel’ if you do not wish to proceed.
5. When the process is finished, the modal will close, and a message will display to let you know if the file was processed successfully or if there was an error.
6. The results will be displayed in the ‘Last Claim Preview File Uploaded & Processed’ and the ‘Recent Claim Preview File History’ sections.
Last Claim Preview File Uploaded and Processed
This section will provide a summary of the claim preview file data that was processed by the system, which includes:
- Uploaded On: The date and time the file was uploaded.
- Uploaded By: Last name, first name of the person who uploaded the file.
- Claim Previews Uploaded & Processed:
- Matched -Total number of claim previews that were matched to a claim in OneSpot.
- Unmatched - Total number of claim previews that were not matched to a claim in OneSpot.
- Total – Overall count of matched and unmatched claim previews.
Note: Matched and unmatched counts will update as claims continue to be matched during the nightly matching process.
An error message will display in this section if an error occurs while trying to import the claim preview file via the auto-sync process. The most common reason for an error is that a claim within the file includes more than four diagnoses. To resolve this issue, locate the claim in RevolutionEHR and remove the extra diagnoses, then try again.
Claim Preview Matching Logic
If you uploaded a claim preview file by using the ‘Select & Upload A Claim Preview File’ button, the claim preview matching will use the below logic:
- Patient first and last name (in either order).
- Payor name.
- Date of service.
- Total charges (box 28 on the claim preview; segment CLM02 of 2300 loop).
If the claim preview file was imported by the auto-sync process (either by automation or, by the 'Auto-Sync Claim Preview' button), the RevolutionEHR invoice ID and the claim ID will be used to match the appropriate claim in OneSpot.
Because a claim preview could exist in OneSpot before the associated claim does, the matching process will run nightly. This process will attempt to match an unmatched claim preview for seven days. Any claim preview that couldn’t be matched within seven days will be ignored.
Recent Claim Preview File History
This grid will display the five most recent claim preview file uploads. If more than five uploads exist, the ‘View All Upload History’ option will display. This button will allow you to view all uploads.
Each row includes the following details:
- Uploaded On
- Uploaded By
- # of Previews
- Processing Status
Select a row to view more details about the file.
The left menu includes:
- Back To Recent & New: This will navigate you back to the 'Claim Preview Files' overview screen.
- Claim Previews: Total number of previews included in the file.
- Matched: Total number of claim previews that were matched to a claim in OneSpot.
- Unmatched: Total number of claim previews that were not matched to a claim in OneSpot.
- Uploaded By: Last name, and first name of the person who uploaded the file.
Grid details:
- Preview Icon: Selecting the icon will open a new tab and display the HCFA.
- External Claim #: The claim ID from RevolutionEHR.
- Matched Claim #: The claim number that the preview was matched to in OneSpot.
- Patient: The patient associated with the claim preview.
- Payer: The payer associated with the claim preview.
- Service Date: The service date of the claim.
- Status: The matching status.
- Active: The claim preview is matched to a claim, or if it’s not already matched, it’s in the queue to be matched.
- Ignored: The claim preview could not be matched and has been ignored. This status will occur if the claim preview is a duplicate or if no claim match was found.