Scrubbing Claims is the first step to correctly and completely process claims electronically for Adult Day Care and other Elder Care Service providers. Scrubbing Claims allows ElderSuite the chance to check claims for any errors which would prevent the claims from processing successfully when submitted electronically. During the Scrub Claims process, ElderSuite will also attempt to fix any errors found. If ElderSuite is unable to fix a claim's error(s) automatically it will tag that claim as having errors. Any claim tagged as having errors must be fixed manually by the user the claim will be processed further by ElderSuite.
To display the Scrub Claims window, with your mouse click the Claim Center button located on the ElderSuite Navigation bar as pointed out in the image below.
After the Claim Center is displayed, click the Scrub Claims button with your mouse as pointed out in the image below.
After the Scrub Claims window is displayed, it will show a list of available claims for the current week. If there are no claims found for this time period, it will notify the user with a message in the grid as shown in the image below.
To change the claims which are displayed in the Claims grid simply change the Start Date and End Date to match the dates of any claims to be displayed. After the Start Date and End Date has been changed to the desired values, click the Find button as pointed out in the image below.
After clicking the Find button in Step 4, ElderSuite will search for any claims matching the dates provided. Any claims found matching the dates provided will be displayed in the Claims grid as show in the image below. If there are no claims found for the dates provided, the message shown in Step 3 will be displayed.
Each claim found and displayed in the Claims grid will have a Scrubbed Status icon displayed to the left of the claim. The Scrubbed Status icons are displayed below with each icons status explained.
|Scrubbed - No Error(s) Found|
|Scrubbed - Error(s) Found|
After claims are found and displayed in the Claims grid the user should click the Scrub & Fix button as pointed out in the image below.
After clicking the Scrub & Fix button, ElderSuite will analyze each claim and adjust the Scrubbed Status icon for each claim as shown in the image below.
After ElderSuite has finished analyzing the claims, there will be no claims which show the Scrubbed Status icon. Instead, all scrubbed claims will only have the or Scrubbed Status icons. The user should now browse the scrubbed claims and ensure that there are no claims with the Scrubbed Status icon. If any of the scrubbed claims show the Scrubbed Status icon, then these claims contain errors. The user must Edit and fix these claims before ElderSuite will process the claims further.
To Edit a claim, select the claim with your mouse and click the Edit button as pointed out in the image below.
The claim chosen to be edited in Step 8 will be displayed in the Claim window as shown in the image below. Any areas highlighted in yellow contain errors and must be fixed. In the initial view of the Claim window, it doesn't appear to have any any errors. However, ElderSuite notified us that there was an error. So, we need to ensure we have scrolled down to scan the complete form and to check thoroughly. You can scroll down the form using the window's scroll bar as pointed out in the image below.
In this example, the claim is missing the ICD-10 Diagnosis Code. After scrolling to the bottom of the form we can see the error is now visible as shown in the image below.
After correcting the claim and moving to a new field, the highlighted error will disappear and no longer be shown as containing an error. If the field is still highlighted yellow, then it still contains errors. After fixing the problem, simply save your changes by clicking the Save & Close button as pointed out in the image below. The changes will be saved and you will be returned to the Scrub Claims window.
After you are returned to the Scrub Claims window, the previously displayed Scrubbed Status icon should be changed to the Scrubbed Status icon as shown in the image below. If the claim is still showing that it contains errors by displaying the Scrubbed Status icon, then you did not fix all of the found errors will need to return to Step 8 and fix all errors.
After you have fixed all errors you can save your changes close the Scrub Claims window by clicking the Save & Close button as pointed out in the image blow.
After following these steps and completing the Scrub Claims process, you are ready to move to the next step in the electronic claims process, Processing Claims.
Please Note: Any claims "Not Scrubbed" or which still contain error(s) will be NOT be processed further by ElderSuite until they have been scrubbed and contain no errors.
Medicaid, Medicare, private insurance, and most other payers have a deadline for claims to be successfully submitted after Adult Day Care services are rendered. If your Adult Day Care claims are not submitted successfully by the payer's deadline then that will be lost revenue. We call these Rotten Claims because they have been left to spoil.
If you are unfamiliar with the automation services ElderSuite provides, I recommend that you review this document: Getting Started with ElderSuite - Your First Steps. This document is recommended reading for all ElderSuite users and explains in detail how ElderSuite's automation services works. It points out what areas of data within ElderSuite need to be paid special attention. It explains how ElderSuite implements automation services and uses the data provided by users to complete tasks automatically. The focus is to ensure that data input into ElderSuite is complete and accurate which will save time.