Billing Implementation Guide

1. Review your submission report to ensure there are no claims stuck in pending. The items in the submission report should have switched from “Pending” to “Billed”.

Example of how claims should look before submitted out

Example of how claims should reflect once submitted

2. Log into the clearing house to ensure that your claims have now shown up under session results and do not show any rejections. http://www.mdon-line.com/mdonline

Example of how claims will reflect in MDOL

The example above shows two claims acknowledged by the payer, and one claim rejected by the payer. Acceptances or Acknowledgements mean the claims are processing at the payer they were submitted to. Rejections mean additional review is needed and the payer will not have these claims on file.
All claim information can be shown by clicking the session tracking number. Rejections can be reviewed three ways, the easiest would be to click the number in the rejected column.

Example of a rejection message

3. Rejections then can be corrected in your AccuPoint site.

Please update any corrections in both client edit info & insurance numbers.

4. Corrected claims then need to be resubmitted through your submission report. Status of claims need to be switched from “Billed” to “Pending”. After the status is updated, please click on update billing status this will commit your changes If claim is already marked as ready to bill (checkbox is greyed out and checked), this claim will then submit out with the revised information.

Before

After

To save changes to billing status

5. Claims are batched nightly after 5pm EST (M-Th) and after 4pm EST on Fridays. Check MDOL to review revised claims and ensure they are processing appropriately.
Five business days (and weekly, thereafter): Your team should log into the clearing house and ensure that there are no rejections regarding your claims. Some rejections can show up to 5 days after submitted. If there are any rejections you do not understand, please setup a 15-minute review meeting with our billing team.

Ten business days and after: Your team should look out for payment! As soon as payment is received (or status of claim is paid) – please let your AccuPoint contact know. If you have a portal login for your payers, check to see if claims have been paid. If you do not have a portal, you may call the insurance company. There are times that an insurance company can take 30 days or longer to issue payment. If there are any errors in your submission report, please review and setup a 15-minute review meeting with our billing team if you do not understand the error message. At this point in time you should receive electronic remittance advice via MDOL – which AccuPoint will download and upload into the system on a nightly basis. If your enrollments are complete and you are not yet receiving remittances electronically (and MDOL supports ERA’s for your payer); please send us an email with your company name in the subject – followed by your tax ID number, payer ID that is missing the remittance as well as the check (or ACH) number, date and amount.

Example of ERA’s reflecting in MDOL

Do not include any PHI as this file needs to be sent to the clearing house for them to research. Any ERA’s that are not received via the clearing house will need to be posted manually using the payments report so making sure receipt of these is of the upmost importance. The AccuPoint team can teach you how to post a remittance manually, if necessary.

After payments have been received: You are good to go live with your billing! This is typically determined by a payer by payer basis. AccuPoint strongly advises against submitting claims via the AccuPoint system until successful test billing has been returned and payment is received as severe interruption in cash flow is possible