Submitting claims
The simplicity with which claims and statements are handled by GoalMinder Account Manager (GAM) is clearly one of its major strengths. In this chapter you will learn how to submit claims to third-party payors and how to send statements to clients. Most GAM users find it so easy to do that they submit claims on a daily basis, thus achieving very rapid turn-around of service-claims-payment cycles.
We have included more than 425 companies in the database that comes with GAM, but only a few currently handle electronic billing. Look for updates and check our website, www.goalminder.com for new additions. We'll let you know when companies are ready to receive e-forms and when we are ready to send them to those companies.
All about Claims
Should I send HCFA or Electronic Claims?
Basically, GAM allows you to send a claim using a HCFA-1500 "red" form or to submit the claim electronically, directly to the payor. The choice of which type of claim to submit is dependent upon a) whether the insurance company is prepared to receive electronic claims directly from you, and b) whether GAM includes the protocol for the electronic submission required by that particular insurance company. Our staff is preparing many electronic protocols. Please consult the users section of this site to make sure a given protocol is available before attempting to submit. See the appendix of this manual for a list of which insurance companies GAM can currently bill electronically.
General issues about printing HCFA claims
We assume that you know how to print using Windows 95/98/NT and that your printer is correctly connected to a printer you will use for that purpose. Either a laserwriter or an inkjet printer is fine, as long as you can load your HCFA forms into the printer. In most cases the program lets you set printing choices before operating. In some cases, however, you need to have the printer you are using set as the default printer before asking for the print job. If you print directly from a Print Preview screen, that routine will use your default printer without first checking with you. In that case, set the printer of your choice as the default ahead of time by selecting Settings/Printers from the Start menu.
To send HCFA claims, you will need a supply of blank red HCFA 1500 forms which can be loaded into your printer. Several sources are available for purchase of these forms. If you don't know where to obtain them, check the users' area of this website for information (www.goalminder.com).
General issues about sending electronic claims
To send a claim electronically, it is essential that you have your computer equipped with a modem and with software that supports sending email. Under most circumstances, you will be using GAM rather than the insurance companies' software.
Preparing HCFA Claims with GoalMinder Account Manager
To prepare a HCFA form, the service must first be posted through the Charges area. See the Posting area before attempting to send a claim!
Assuming that some charges have been posted, do the following:
- Navigate to the HCFA area by pressing the HCFA button on the Main screen:
You will see a screen that organizes the processing of claims into three major submission tasks:
- Submissions of claims to primary policies for the first time
- Submissions of claims to the secondary policy after receipt of payment from the primary policy
- Resubmission of claims to payors who have not responded to the initial claim within a given number of days.
These choices cover every "bulk" category of submissions. In each case they are accomplished as follows:
- Select a claims job you wish to process by clicking on one of the three radio buttons shown on the left-hand side of the "Typical" panel of the HCFA area.
- Load your printer with HCFA 1500 forms.
- Choose Printer or Print Preview by pressing the appropriate radio button on the right-hand side of the screen.
- Press Run
- If you have selected the preview option, you can print directly from the resulting display by clicking the printer icon on the bottom of the form after you have reviewed the print job. The printer icon is the 7th button on the bar, counting from the left.
- If you selected the Printer option, then the job will be sent to your default printer without displaying the claims information on the screen. This usually the faster way to go.
