Generating and Transmitting Claims

Table of Content

  • Introduction
  • Prerequisites
  • Generating Claims
  • Transmitting Claims Electronically via SFTP
  • Transmitting Claims Manually
  • Recreating Claims Batch Files
  • Making Changes to Transmitted Claims

Introduction

This article will walk you through the process of generating and transmitting claims from your General Case Management (GCM) system to Waystar (claims clearinghouse).

Prerequisites

  • You must have Enterprise Financials & Enterprise Claims
    • If your agency doesn’t currently have this option and you’re interested in learning more, please contact success@extendedreach.com
  • Your agency must contract separately with Waystar (claims clearinghouse)
    • You must complete set up with Waystar prior to using these features. This must be set up and managed by your agency and Waystar
  • Transmitting claims electronically requires you to
    • Tell Waystar you will submit claims via SFTP (Secure File Transfer Protocol)
    • Create a password for the SFTP and provide it to eR for set up
    • If you’re unsure if this is set up, please Contact Support at support@extendedreach.com
  • You must be a Billing Administrator or Full Administrator and “Restrict visibility of financial information” must be unchecked on your User Group or User ID
  • There must be some billable activities in a Completed status for cases with Insurance selected on the Case > Insurance tab

TIP- Please Contact Support at support@extendedreach.com before making modifications to your Financial settings.

 

Generating Claims

Go to Organization Billing > Claims: Generate. You can generate desired claims by either method

  • Select them by checking the box next to the claim and then go to Generate Claims > For Selected
  • Go to Generate Claims > Through Date and enter a specific “Through Date” (for all claims prior to that date)

Above screenshot shows the navigation to Claims: Generate

Above screenshot shows the Generate Claims Options screen

Prior to generating, you can click on “Group By” to change it from the default of “List by Date” if desired.

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Above screenshot shows the Generate Claims Grouping options

You should regularly go to Show > Do Not Generate to review billable activities that are not ready to claim. Common reasons for this that may need your attention are there was no Insurance on the Case > Insurance tab at the time the activity was created or an Authorization is required but isn’t selected on the activity.

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Above screenshot shows the Do Not Generate option

If the Insurance is on the case now, edit the activity and save it. The insurance will automatically be linked now. If an authorization is required and is on the case now, edit the activity and click on the authorization link to select it. Go to the Billing tab of the activity to see if "Do Not Claim" is checked. If it is, uncheck it, and click Save. The activity should now be on the “Ready to Generate” view.

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Above screenshot shows the Do note create claim option checked

Activities that are billed to the client (self-pay) or billed to a Funding Source will remain on this view because they don’t get sent to Insurance on a claim. No action is required for these. 

Transmitting Claims Electronically via SFTP

NOTE: This requires SFTP be set up with Waystar and eR. See prerequisites section at the top of article for details.

After the claims have been generated, they will move to the Organization Billing > Claims: Ready to Transmit view and the system takes you to this screen. This is the claims “outbox”

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Above screenshot shows the Ready to Transmit Claims screen

  • Do not click “Transmit Claims” from here (this is Manual billing method). If you do, the claims will need to be manually uploaded into Waystar (described below under Recreating Claims Batch File).
  • To transmit claims automatically overnight, simply leave this screen. The system will create a batch with all claims in this view and transmit it to Waystar overnight. To confirm transmission, the next morning check for the claims in Waystar and/or go to System Settings > System Configuration and in the “Transmit Electronic Claims by SFTP” section the “SFTP Finished” field (outlined below) should be populated with yesterday’s date. If you do not see this section, electronic claims are not enabled in your system.
  • To transmit claims immediately, go to System Settings > System Configuration and in the “Transmit Electronic Claims by SFTP” section click on “Transmit Claims Now”. Wait a minute or two for them to process. Then refresh your screen and you’ll see today’s date and time they were transmitted in the “SFTP Finished” field. The claims should now be in Waystar.
  • After either process, the claims will now be in a batch under Organization Billing > Claims: Transmitted Batches.

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Above screenshot shows the Ready to Transmit Claims screen

NOTE: If you see “No claims found to transmit” in the “SFTP Finished” field, that’s normal if you didn’t generate any claims the previous day.

TIP- The most common mistake is to click on “Transmit Selected Claims” after generating. That removes the claims from the “outbox” so there is nothing there when the system tries to transmit claims. You must leave them there for the electronic transmission to work.

Transmitting Claims Manually

After the claims have been generated, they will move to the Organization Billing > Claims: Ready to Transmit view and the system takes you to this screen. Click on Select All to transmit all claims then click on "Transmit Claims" or select specific claims then click on "Transmit Claims". 

Above screenshot shows the navigation to Claims: Ready to Transmit

After the claims are transmitted, they will now be in a batch under Organization Billing > Claims: Transmitted Batches. You must now Recreate the Batch and upload it in Waystar.

Recreating Claims Batch Files

Go to Organization Billing > Claims: Transmitted Batches. Click on “Recreate Claims Batch File“ and a pop-up will appear.  Enter the desired batch number (leading zeros aren’t necessary) then click "Submit"

Above screenshot shows the navigation to Claims: Transmitted Batches and Regenerate Batch option

After you click Submit, the pop-up will refresh and display a file to download. Right click on the file name and select "Save Link As". Save the batch file to your computer, making sure to keep it as a .txt file, and then upload it in Waystar. It’s best if you don’t open the file.

Above screenshot shows the navigation to download a batch file

Making Changes to Transmitted Claims

After claims have been transmitted to Waystar, they cannot be modified and retransmitted. Any changes that need to be made to the claims will need to be made directly in Waystar. 

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