Note: Before you can send claims from EDS to insurance carriers, you will first need to send them from your Eaglesoft software to the EDS Bridge.
Each time you send an electronic claim from the Eaglesoft software, the claim is first sent to the EDS software and clearing house for a validation check. Validation ensures that your claims include all the required information and attachments prior to submission for faster reimbursement and fewer delays and rejections.
Based on the results of the validation check, claims appear on the Manage Claims tab of the EDS Bridge.These are claims that have been sent to EDS today or any claims from previous days that still require additional information. These Claims At EDS are categorized into one of four areas:
· EDS Review - The validation found something in the claim that requires further review by someone at EDS before EDS can submit it for payment. There is nothing you need to do on this specific claim. It will give you a description of what's going on in the lower right corner.
· (Office Review) - Claims listed here require someone from the office to review them and approve their submission. (This will not apply to most offices.)
· Rejected - The validation rejected the claim due to errors. You will see a description in the lower right corner.
Tip: You can also see any errors on the claims by moving your mouse pointer over the caution sign to expand the description.
To fix a claim, right-click the claim and click Edit Claim to edit it. By editing a claim within this window, you will be able to see the complete error at the top of the window and also navigate anywhere the claim needs to be edited. After you edit the claim, click Save, and the claim will get reviewed again. It's possible for a claim to move from "Rejected" to the "Requires attachment" category due to you fixing one issue.
· Requires Attach - The claim requires one or more attachments before EDS can submit it for payment.
Note: Attachments are based on procedure codes and requirements directly from the insurance company. If the carrier flags the claim for an attachment, you will have two ways to meet the requirement:
· Right-click on the claim, and then click Manage
Attachments to fix the attachment issue. Look at your procedure
codes to see what code is flagged. If needed, you can type a narrative
in the box in the lower left corner. If there was a remark, it will appear
at the bottom. If you want to copy the claim notes over to the narrative,
click Copy Claim Notes to the Narrative. You
can add an attachment using either the Capture Screen
button or the copy
From Clipboard button.
Clicking the green Capture Screen button closes the window
and allows you take a screen shot. You'll be able to take a screen shot
by clicking and dragging a box over the image. From there you can do an
X-ray or Non X-ray. Your non-X-rays will be EOB's, Narratives , and Periodontal
charts. X-rays will be images such as bite wings, full mouth series, etc.
After that, you will need to determine the image type.
Clicking From Clipboard copies any recent image from your
Windows Clipboard. For example, to capture an image on your desktop, you
could right-click the image, click Copy, and then use
the copy From Clipboard button. That image is then added
as an attachment.
Once you've added your attachments, click Save in the
upper right corner. The paperclip that was red will turn green. To
get claims to a ready-to-send state, select the check box to the left
of the paperclip for each claim you want to send.
· Right-click on the claim, and then click Remove Attachment Requirements to remove the attachment.
· Ready to Send - The validation passed, and the claim is ready to submit for payment.
Note: The EDS bridge does not refresh on its own. In order to see the claim in the Ready To Send state after making changes, you will need to click Load again.
At the end of the day, at 7:45 CST, any claims with a Ready To Send status are submitted electronically to the respective insurance payers for payment. At that time, any claims still in EDS Review, Rejected, or Requires Attach will not be sent and will remain in those states until your offices address the issues that have been identified.
Important: Make sure that your claims attachments are also ready, and remember to select the claims and click Send Attachments or those claims will not be sent.
To learn more about how to address claims issues, click one of the topics below: