Filing a Coded Claim

AngelTrack's postprocess workflow supports both in-house and outside billers. This help document is for in-house billers and for outside billers who choose to integrate (i.e. who choose to use AngelTrack remotely to perform billing on the customer's behalf).

If you are not yet familiar with the numbers 837P, 999, 277CA, and 835, or if you do not yet know how your billing software, your clearinghouse, and the insurance carriers all work together, then read the EDI Primer first.

Calls Must be Coded First

As we know, dispatches must first be coded before submission to the clearinghouse. Coding in AngelTrack is fast and easy, because most of the datafields are filled-in for you, from AngelTrack's dispatch and PCR records.

AngelTrack's coding system is ICD-10, but you can manually input ICD-9 codes if you wish. Read the Coding guide to learn more.

Transmission to the Clearinghouse

The Insurance Filing Queue produces completed 837P documents suitable for upload directly to your clearinghouse. After downloading the documents from AngelTrack, you must upload them to your clearinghouse using its web interface (or its uploader application, if any).

After performing the upload, be sure to record the relevant "Claim filed" events in AngelTrack, so as to keep a record of when the claims were filed, and by whom. The Insurance Filing Queue has a button for creating those events with just one click.

Unsupported clearinghouse

If your clearinghouse rejects one of AngelTrack's 837P documents, then contact AngelTrack Support. Every clearinghouse has fiddly little requirements for its 837Ps, and so every clearinghouse produces an "837P Companion Guide" detailing these requirements. If you provide that guide to AngelTrack Support, they will review it and give you a timeline for implementing it. That way you won't need to switch clearinghouses.

Insurer who does not accept electronic claims

If you must deal with an insurer who refuses electronic claims, remind them that federal law 42 USC § 1320d-2 and federal regulation 45 CFR Part 162 require all HIPAA-covered health plans to accept electronic transactions, and to do so in the standard format (X12.837) provided by AngelTrack. A refusal to do so can get them shut down, so maybe they just need a reminder.

If that doesn't work, or if the insurer claims to be somehow exempt from the law, then you must file your claims on the old-fashioned CMS-1500 paper forms. The good news is, AngelTrack will fill out your CMS-1500 forms for you. To learn more, read the Filing a Paper Claim guide.

Processing the Clearinghouse's Reply

Your clearinghouse should reply with an X12.999 document, which is an electronic datafile that tells AngelTrack whether the batch of claims was accepted or rejected. If the batch was rejected, the datafile will include an explanation.

After you've downloaded the 999 document from the clearinghouse, you must give it to AngelTrack for processing. You can do this right from the Insurance Transmission Queue:

Insurance Transmission Queue clicking the plus sign in the "997/999 Reply" column. It doesn't matter which plus sign you click; AngelTrack will figure out which batch the 999 document belongs to. You don't have to keep track of which 999 goes where.

If the 999 document is a rejection, then all of the claims in the batch will be marked "failed", and all of the dispatches in the batch will go back to the Insurance Filing Queue (or Insurance Exception Queue if that's where they were before) to be re-coded and re-batched. In that event, the Coding page will have a "Last 997/999" tab that you can click to see why the batch was rejected.

Rejections from a clearinghouse are rare, and should not occur under normal circumstances. If your clearinghouse is rejecting AngelTrack's batches, please contact AngelTrack support to get it cleared up. Your clearinghouse may have an unusual requirement that AngelTrack does not yet support.

To learn more, refer to the Batch Management guide.

Processing the Replies from the Carriers

The insurance carriers should reply with X12.277CA documents, which are electronic datafiles that tell AngelTrack which individual claims are accepted for adjudication versus which are rejected. Your clearinghouse will collect the 277CA documents from the carriers, and make them available to you for download. After you download them, feed them into AngelTrack just like you did with your 999 document.

277CA documents can reject individual claims, rather than whole batches. AngelTrack will process the 277CA document looking for rejections. Any rejected claim will be marked as such*, and then its dispatch will go back to the Insurance Filing Queue (or Insurance Exception Queue if that's where it was before) to be corrected and re-batched. When that happens, the Coding page will have a "Last 277CA" tab which you can click to see the reason for rejection.

Rejections from carriers are common, and occur for all sorts of reasons including invalid patient ID number, invalid group number, invalid SSN or DOB, expired policy, invalid diagnosis codes, missing modifiers, etc. etc.

To learn more, refer to the Batch Management guide.

*When a claim is rejected by the clearinghouse or by a carrier, the corresponding "Claim" payment event in AngelTrack will be marked "failed", and the relevant 999 or 277CA document will be attached to the payment event for review. AngelTrack will decode the document into human-readable format for you.

Download of EOBs Later

Once a day or once a week you will download EOBs from your clearinghouse, showing the status of your claims. AngelTrack will process the EOBs for you, provided they are available from your clearinghouse in X12.835 format.

To learn more, read the Importing EOBs guide.

Manual input of non-X12 EOBs

If your clearinghouse does not provide EOBs in X12.835 format, then you must manually read and record them in AngelTrack. Each claim line in the EOB should become a payment event which reflects the insurer's reply. These payment events then drive AngelTrack's postprocess workflow.

AngelTrack Help Index - AngelTrack Support