Manual Submission - Drop to Paper In-house

How do I know what the payer rules are?

Insurance companies have rules on how they want to receive claims. There are two options, you can submit through a clearinghouse or drop to paper in-house (manual submission). If the insurance is the primary or secondary payer, the rule could be different. The short answer is, go to your clearinghouse to ensure that you are following the correct rules. Let's use Waystar as an example.

  1. Log onto Waystar.

  2. Go to the bottom and click Payer list.

    Log onto Waystar and click on payer list at the bottom of the page.

  3. Enter the name of your payer in the search bar.

    Enter the name of the payer in the search bar at the top.

  4. Check the rule for the payer - primary or secondary submission.

    The payer list shows paper or electronic.

Set manual submission in Admin

If the rule for the payer requires a paper submission, you will need to configure that setting for the payer in Admin. Here's how:

  1. Click Payers on the navigation bar.

  2. Click the name of the payer or start typing the payer name in the search bar to find the payer in the list.

  3. Click the insurance name in the search results.
  4. Click the Policies tab and then select the policy from the list.

  5. Click the "Primary submission" and/or the "Secondary submission" field and select Manual submission from the drop-down list.

  6. Click Save & Close.
  7. Select the Benefit plans tab and then select the plan from the list.

  8. Scroll down and find the 'Primary submission' and/or the 'Secondary submission' sections. Ensure that these fields are set to Manual submission.

  9. Click Save & Close.

    From this point on, queued claims for this payer will appear on the Manual Submission Queue page under the Claims menu.

Accessing claims for manual submission

There are a couple of ways to access claims that require manual submission.

Dashboard: Click Dashboard on the navigation bar.

  • Under "Claims by status" heading: Manual submission claims displays under "Queued for submission."

  • High priority claims: If the number is greater than zero, a Work button enables next to the "Queued for submission - Manual submission" title. Click the Work button to get started.

 

Modify what prints out on the 1500 & submit

Printing a 1500 batch

  1. On the navigation bar, click Claims and then select Manual Submission Queue. This page lists all the batches that are waiting for manual submission.

  2. Click the "CMS 1500 margin settings" link on the Manual Submission Queue page to verify or change the margins.

  3. Find the payer name in the list or use the search field to enter the payer's name. On the line associated with your selected payer, click the Submit button. A "Manual Submission Queue" form will display.

    Note: Options you select will stay selected for this payer so they can be used in the future. If you wish, you can change them anytime.

  4. Options can be changed by clicking the edit icon next to the header. After verifying the options, click Print and mark submitted. This marks the claim(s) as done and removes the claims from the Manual Submission Queue page.

    The 1500 form displays in a separate tab in your browser.

  5. Load 1500 forms in your printer and click the print icon.

    Once printed, the claims will change from a "Queued for Submission" status to a "Submitted – Manual Submission" status. Both the Audit Trail and Billing Lifecycle will reflect the submission and the actual printable PDF can be seen from the Submission History tab on the claim page. If you need to reprint the entire batch navigate to Claims > Claim Batches and reprint from there.

Printing a 1500 from the Claim page

  1. Enter the claim number in Search.

  2. On the Claim page, click Print 1500.

    If the payer is set up for paper, you will see a 'Get CMS 1500 & mark as submitted' button.

    A "Manual Submission Queue" form will display.

  3. On the form, verify the options.

    Note: Options you select will stay selected for this payer so they can be used in the future. If you wish, you can change them anytime.

  4. Options can be changed by clicking the edit icon next to the header. After verifying the options, click Print and mark submitted. This marks the claim(s) as done and removes the claims from the Manual Submission Queue page.

    The 1500 form displays in a separate tab in your browser.

  5. Load 1500 forms in your printer and then click the print icon.

    Once printed, the claims will change from a "Queued for Submission" status to a "Submitted – Manual Submission" status. Both the Audit Trail and Billing Lifecycle will reflect the submission and the actual printable PDF can be seen from the Submission History tab on the claim page. If you need to reprint the entire batch navigate to Claims > Claim Batches and reprint from there.

Printing a 1500 from the CMS 1500 report

Use the CMS 1500 report to generate a single page that can be printed onto the CMS 1500 form. Record the claim number before you begin.

  1. On the navigation bar, click Analytics > Reports > CMS 1500.

  2. Enter the claim number and then fill in the options.

  3. Click View Report.

  4. Load 1500 form in your printer and then click the print icon.

Submission history

Submission history can be found in the "Audit trail" and "Billing lifecycle" tabs on the Claim page. You can also go the "Submission history" tab to view the 1500.