Billing Claim/Invoicing FAQ

Q: How do I check a client’s Medicaid eligibility in OnTarget?

A: Medicaid batch eligibility checks are available in OnTarget for North Carolina Medicaid recipients. The report is run monthly and dropped in Reports/Published Documents/Eligibility folder by the 5th of every month. Eligibility can also be seen under Clients/General/Eligibility tab.

Q: Does retracting a note zero out the note and pay the claim back to the MCO/payer?

A: For most payers*, if a claim has been billed and paid by the payer, retracting a note will trigger the claim to be recouped. If there are additional units to bill the claim will be sent as a replacement claim with the updated units. If there are no units, then the payer just receives a voided claim which will recoup the money originally paid. *If a payer has ‘Override NU’ checked the payer does not allow this process.

Q: How do I rebill claims in OnTarget?

A: There are several ways to rebill claims in OnTarget. Please check out this video for a tutorial for rebilling claims. All claims can be rebilled via OnTarget, but should first be researched to determine the reason for the denial, and if the error is on the agency or payer side. Please refer to the OnTarget Rebill Process, as well as the Written Material Rebilling Claims for the steps to rebill each specific scenario, Contact billingsupport@ontargetclinical.com if you have additional questions.

Q: How do I know which denial codes can be rebilled in OnTarget?

A: All claims can be rebilled via OnTarget, but should first be researched to determine the reason for the denial, and if the error is on the agency or payer side. Please refer to the OnTarget Rebill Process for the steps to rebill each specific scenario, which may already be available in the Reports/Published Documents/Miscellaneous folder. Contact billingsupport@ontargetclinical.com if you need a copy of this process.

Q: How do I upload third party insurance correspondence/EOBs/RAs in Trillium’s Provider Direct Claims Department?

A: Please contact Trillium Network Services at NetworkServicesSupport@TrilliumNC.orgor call 1-855-250-1539 for assistance.

Q: How do I upload third party insurance correspondence/EOBs/RAs to Eastpointe’s Alpha+  and/or the claims department?

A: Please contact your Eastpointe claims specialist or claimsfunding@eastpointe.net for assistance.

Q: If a client has a BCBS plan outside of our state how do we process the claims?

A: All BCBS plans need to be filed to the local plan for the state the provider’s office is in regardless of the state the client has a BCBS plan in. BCBS will process all claims to the appropriate plans. For NC, all audit reports for BCBS claims are in OnTarget/Reports/Published Documents/BCBS of NC/Audit Reports or Billing Rejections. This report contains a control number for each claim; this can be provided to the out of state plan if checking with them directly regarding claim status of accepted claims.

Q: Why do I have unprocessed claims (no denial or payment)?

A: There could be several reasons why claims are unprocessed in OnTarget. Here are the places to check in OnTarget on a regular basis for before reaching out to the payer:

• Go to Claims/837 Status. Check that the claims submitted have an "Accepted" status. If they have "Rejected", go to Reports/Published Documents/837 Responses and check all response reports from the payer to make sure there were no rejections. (To determine the 837 file, check the serial number column on the claims grid, then match that serial number to to 837 serial number). Access to the 837 Status feature is granted by your security administrator under Configure/Security/Configure Role/Desktop Security/Claims.
• Go to Reports/Published Documents/Billing errors folder in OnTarget, These are claims which could not be exported to the payers due to missing or invalid information. Please review the AA Department Common Billing Errors_Provider Version document for common billing errors and how to resolve.
• Go to Reports/Published Documents/Billing Rejections. Our billing team saves a report of any rejections the payer sends us after the claims are submitted. This is a second level adjudication and not related to the 837 Status. Rejections are claims that make it to the payer, but will never make it to an EOB/RA/835. 
• For NC EVV claims only: Go to Reports/Published Documents/HHA Responses. Check the very last column of the report for the response from HHA. If the response is "Success" then claims made it to HHA. There could be several more layers of processing within HHA but this first step is critical each week to make sure they did not reject on the first submission.

Q: How do I know my claims have been sent to the payer from OnTarget?

A: There are several ways to confirm in OnTarget that claims have been sent to the payer:

• Check the Status column of the claims--if they show "Confirmed" they were sent to the payer, then look for the Serial number column.
• Under Claims/837 Status if the serial number of the file shows "Accepted" then the payer accepted the file.
• Under Reports/Published Documents/Transmission Logs there is a report of all claims sent.
• Under Reports/Published Documents/837 Responses, for each payer there are reports that show proof of filing and acceptance.

Q: How can I bill unpaid claims past the payer's timely filing limits as a replacement claim in OnTarget?

A: Payers that request a replacement claim for a previous claim reference number to extend the timely filing period have two options. One option is to enter the claims (CMS1500) in the payer portal or website as a replacement claim with the original denied reference number. The second option is having our team send the claims manually. For the second option we will need the following information sent in a spreadsheet: Client First and Last Name, date of service, service code and modifier, site name, current invoice number in OnTarget, and claim reference number needed to send the claim. The reference number can be found in payments in OnTarget or on the actual RA from the payer. Please send this information to billingsupport@aymira.com or your assigned account analyst. 

Q: How do I check or change the service location/place of service for a claim?

A: Go to the Authorization grid, search for affected authorization. Open the authorization and click on the service from the claim to see the Service Location. If it needs to be updated, click on the service location dropdown, choose the correct one, then click Save on the authorization. The claim can then be rebilled (Rebill Selected if a payment or denial has posted in OnTarget). If the service location needed is not in the dropdown, it can be added by going to Configure > List Configuration > Billing > Service Location. Note: some agencies may have the service location controlled on the note-if so, then a note edit must be done to update the service location on the claim instead of editing the authorization.

Q: How do I change the service location/place of service for a claim when my agency has the setting "Enable service location on note" checked?

A: Here are the steps for editing the service location on a PIE note when this feature is enabled:

• The claim must be voided from the Claims grid (Void Only-unpaid claim, or Void Notify Payer-paid claim).
• The note then needs to be unapproved, unsigned and the office location updated, then note resigned, reapproved.
• The note revision must be reimported from Notes to Time Records.
• The time record can then be batched and invoiced again.

Q: How do I resolve the following fatal error: A fatal error was encountered when exporting claims for Error: An unconfirmed batch exists.

A: This error normally resolves once automation finishes clearing the previous claim export. If you continue to get this error after 2 hours, or you are within an hour of a billing cutoff, please reach out to billingsupport@ontargetclinical.com so we can triage and confirm any batches that need to be confirmed.

Q: How do I resolve the billing error: Invoice Line cannot be matched to a billing provider assignment with a billing configuration?

A: Check the claim and make sure the site is appropriate for the service and payer being billed. If it is not, please update the site on the authorization, delete the claim from the claims grid, re-batch, and re-invoice. If the site is correct, please submit a ticket to billingsupport@ontargetclinical.com or contact your assigned account analyst.

Q: How do I resolve the billing error: Billing Provider Assignment is missing on claim?

A: Check the claim and make sure the site is appropriate for the service and payer being billed. Check Billing/Services/Provider Assignments for the service code and payer. If the site you are billing is not on the payer service & this site is on your contract for the payer, please submit a ticket to billingsupport@ontargetclinical.com or contact your assigned account analyst. We will need the service code, payer, site, NPI and taxonomy to add the site to the service. If the site is incorrect on the authorization, delete the claim from the claims grid, update the authorization and recreate the invoice.

Q: How do I rebill a claim with an incorrect insurance ID number?

A: Go to Client/General/Insurance tab. If the current insurance ID is incorrect for all claims, edit the Funding ID for the payer, click Save. If the current insurance ID and payer is correct for previous dates of service, check the ‘Inactive’ box (this does not affect rebills or current authorizations). Select ‘Add Insurance’ to add the new payer and ID. Update the authorizations using the appropriate effective dates and choose the correct funding source to update the ID number on the claim. If claims have posted in OnTarget with a reference number choose Rebill Selected in the Billing/Claims grid. For all other scenarios, please check out this video or email billingsupport@ontargetclinical.com for a copy of our rebill step by step process.

Q: How do I fix the following billing error on claims: Attending provider is missing?

A: Check under Billing/Providers, search for the provider by NPI or name. Verify the payer is listed under Attending Employee Setup. If it is, also check under Employees/Provider tab to verify the payer is listed. If it is not in either/both places, and the caregiver is credentialed for that payer, please submit a ticket to billingsupport@ontargetclinical.com or contact your assigned account analyst to get the Adding Clinician Providers to OnTarget form.

Q: How do I know if my claims got exported from OnTarget on billing day?

A: Go to Billing/Claims and click on the 837 Status button (bottom right). The file name, payer, date, time, status, and total submitted should be listed.

Q: How do I resolve Rejected claims under the 837 Status window?

A: If the status is ‘Rejected’ please go to Reports/Published Documents/837 Responses to review reports for possible errors. Open the file labeled ‘Submitter Report’ from the payer. If the submitter report shows all claims are ‘accepted’ then there is nothing further to do. If there are claims listed under ‘Rejected’ in the payer response file, please locate the claims in the report or in the Velocedi report, correct any data in OnTarget and rebill the claims. Please contact the MCO directly, billingsupport@ontargetclinical.com or your assigned account analyst for any questions.

Q: How do I fix the billing error on claims: Billing provider is missing?

A: Check the claim and make sure the site is appropriate for the service and payer being billed. If it is not, please update the site on the auth, delete the claim from the claims grid, re-batch, and re-invoice. If the site is correct, please submit a ticket to billingsupport@ontargetclinical.com or contact your assigned account analyst.

Q: What do I do if I have already rebilled a claim and notice the service is incorrect before the claims are exported?

A: The incorrect service can be replaced on the authorization with the new service code-the claims will be picked up on the next automated run, or manual claim sweep. If the claims are already exported, then they cannot be rebilled again until the payment/denial has been posted in OnTarget. Please note this should only be done on the authorization if ALL dates of service/notes for that client and all caregivers who worked with the client were incorrect. If all of the notes connected to that authorization should not be updated to a different service, then go to Claims/Delete the claim (choose the Delete option), then ask the caregiver to retract the incorrect note, and write a new note for the correct service.

Q: How do I rebill a claim that was originally billed under the wrong service code?

A: There are two options for this scenario:

• if ALL dates of service/notes for that client and all caregivers who worked with the client were incorrect then the service can be changed on the authorization. This will update all notes, schedules, time records, and claims historically to the new service. The claims can then be rebilled using 'Rebill Selected' if there is a reference number present, or Void Only, then recreate batch billing and invoices. Please also note this should only be used when the frequency is the same for both services (every 15 minutes, daily, etc.). If the frequencies are different between the two services, see second option.
• If all of the notes connected to that authorization should not be updated to a different service, then the caregiver needs to retract the incorrect note, and write a new note for the correct service.

Q: How do I clear a 'BLOCKED' time record in OnTarget?

A: A time record that has billing status of 'BLOCKED' and appears pink/red in the grid, is a time record that was imported after another note(s) for the same client, service and date of service has already been 'billed' or invoice created. Once an 835 or manual payment has been posted and a reference number attached, OnTarget will automatically rebill the claim, combining all units into one claim. If the original claim is unpaid, OnTarget will send a new claim. If the original claim was paid, OnTarget will send a replacement claim. Please see the AA Department OnTarget Rebill Process where this is explained under the 'Helpful Hints' section.

Q: How do I resolve a claim export error of 'Cannot export invoice. General Ledger book closed on: MM/DD/YYYY'?

A: Once a general ledger book period is closed, any claims rebilled or created for dates of service after that date will not process in an export to prevent adjusting that previous period. To resolve this, the period must be reopened, and then the claims can be exported. Once the claims have been exported and confirmed, the period can be closed again.

Q: How do I resolve the validation of 'Service date must be within the service date range'?

A: This error is the result of an authorization edit after scheduling or documenting notes. Check the client's service authorization to ensure you have an authorization for the dates of service attempting to bill. If there is no authorization, edit the auth to include the dates or add a new one to cover the dates. Please review our Common Billing Validations tips to help resolve this and other common issues.

Q: How do I resolve a denial for incorrect or invalid taxonomy code?

A: There are two types of taxonomy codes based on the payer's billing requirements. A billing taxonomy is always sent for the agency on every claim file. In addition, the attending clinician's taxonomy code is sent if the service requires the attending on the claim (Ex: outpatient therapy in many states). Each site, payer and service can have a unique billing taxonomy depending on your payer contracts. Please reach out to the payer to determine which taxonomy they have on file for your agency. If you receive a denial for incorrect or invalid taxonomy code:

• Reach out to billingsupport@ontargetclinical.com (or your assigned account analyst) for a list of the taxonomies in OnTarget being billed per site and payer if this information was not already provided to you.
• Determine what changes, if any, need to be made in OnTarget and send those to billingsupport@ontargetclinical.com (or your assigned account analyst). We will need to know which site(s), payer(s) and service(s) require the update.
• Rebill the claim in OnTarget. If claims have posted in OnTarget with a reference number choose Rebill Selected in the Billing/Claims grid. For all other scenarios, please check out this video or see the  AA Department OnTarget Rebill Process.
• In NC only, EVV files sent from OnTarget have no taxonomy, site or NPI information. Please see our EVV Billing FAQ section for tips on resolving these denials with HHA and the MCO directly.

Q: How do I rebill unprocessed claims with incorrect authorizing payer?

A: Select the claim in the claims grid and choose the ‘Delete’ option (if they have been processed, they would require a "Void only" if unpaid).. Check the Client/General/Insurance and ensure the correct payer is Active. End date the incorrect auth under Authorizations. Add a new authorization using the correct authorizing and funding payer. The time records can then be batched and invoiced again.

Q: How do I rebill unprocessed claims with incorrect funding payer?

A: Select the claim in the claims grid and choose the ‘Delete’ option (if they have been processed, they would require a "Void only" if unpaid). Check the Client/General/Insurance and ensure the correct funding payer is Active and inaccurate ones are marked "inactive". Once fixed, go to the affected authorization, under the service line, and change the payer to the correct payer. The time records can then be batched and invoiced again.

Q: How do I change the DSM5/ICD10/diagnosis so I can rebill a claim?

A: Open the Client Record > Click Medical > Click the DSM5 tab > Select the diagnosis record > Change the ICD10 > Make sure that the 'Primary' checkbox is checked > Click Save.