This page will detail the process behind sending a claim from TRAKnet 3.1.
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Sending a Claim
After creating your claim and scrubbing the claims, you must send these claims from TRAKnet to a Clearing House, Clearinghouses, where they will then be forwarded on to the insurance company. Claims are sent from the Billing Dashboard of TRAKnet 3.1 under the "Claims" screen.
The Claims Queue
After a claim has been marked "bill ready," that claim will appear in the claims queue. When in the claims screen under the Billing Dashboard, you will notice several views. These are:
- Claims Pending - Unsent — This view will display all claims that are marked bill ready, have no claims history, and are ready to be sent.
- Claims Built - Unsent — This view will display all claims where they have been selected to send once but did not send through to either the clearing house (when electronic claims) or the printer (when a paper claim). An issue of some kind may have prevented this from going through. Claims can be resent by checking the box next to each claim and clicking Send.
- Claims Sent — This view displays all claims that have been successfully sent. It will show the date sent, the note date, patient information, balance information, insurance, the method of how it was sent, who sent it, what the batch number was, and which computer the claims were sent from.
- Remits - Processed — This view will display all ERAs - or electronic remittance advices - that were successfully downloaded and posted from Trizetto.
- Remits - Not-Processed — This view will display all ERAs that were selected to download but did not successfully download for one reason or another.
- Patient Responsibility — This view will display all items that TRAKnet believes should be patient responsible. These claims might be $0 remaining, might have no insurance set, or might have had a secondary payment posted before the primary payment. This list should be checked regularly to keep the list sorted and under control.
Sorting the Claims Queue
The Claims Pending - Unsent view is the view that will primarily be used when sending out a claim batch. On this view, there are several filtering and sorting options that will allow the user to see only certain claims.
Claims can be sorted by:
- Date Range, based on Note Date
- Sequence, such as Primary, Secondary, or Tertiary
- Output, such as paper, electronic, or none
- Positive Balances Only
You can select all items in the claims queue based on their output with the "Select" drop-down menu and the related criteria.
Sending Claims
To send claims, simply check the box next to the claim you wish to send and click Send. These claims will be placed in one claims batch file before being sent to the clearing house to be forwarded to the payers.
After sending claims, we recommend clicking the Gateway EDI icon to navigate to your Trizetto website portal and then clicking the Confirm File Delivery option to ensure your claim file is received. Please wait 5-10 minutes for this to process.
How Does it Work?
Behind the scenes, TRAKnet is communicating with the clearinghouse website through what is called an FTP - a file transfer protocol. The claims you select to send are placed into one file. That file is then sent through the FTP to the clearinghouse for processing.
Likewise, remits you download from the clearinghouse website come through this FTP before being received by TRAKnet.
Your Clearinghouse information is set up through the Clearinghouses screen. If your FTP password is incorrect, claims cannot send. To reset or confirm your FTP password, reach out to the clearinghouses support team for assistance.