The TriZetto clearinghouse makes your life easier by automatically submitting and receiving claims within ChiroUp - no more manual uploads and downloads! However, it is important to note that when you make the switch, it is possible that you may encounter orphan claims.
What is an orphan claim and how should I handle them?
Orphan claims fall into one of two categories:
Type 1: Claims from your prior EHR: These are responses linked to claims that originated in your previous EHR system. In this case, manually post the payment in your previous EHR, then mark the response as Worked in ChiroUp. Marking a claim as Worked will remove it from your view, so only take this action if you don’t need the response in ChiroUp. To verify if the orphaned response belongs, check the date of service. (these are the most common orphan ERAs when a clinic first makes the switch over to ChiroUp EHR).
Type 2: Unmatched Responses in ChiroUp: These are responses that ChiroUp couldn’t automatically match to an existing claim. To handle these, link the orphaned response to a payor on the purchase for the listed date of service. If no matching payor exists (or if it isn’t linked to any payor on the purchase), add a policy before associating. Once the policy is on the purchase, you can assign the payor as needed. The orphaned response will then appear with the batch ERA response in the ERAs tab and will be ready for posting. (see the How to apply a type 2 orphan claim drop down below for step-by-step instructions)
Additionally, there is the possibility for Unapplied responses too, which live under ERAs in the ERA tab - these can also fall under one of the above 2 categories. For unapplied responses that do not belong, you can proceed with deleting them, which just removes it from view.
Where can I view orphan claims?
Navigate to the billing module on the left side of your screen and select the Orphaned Claim Respones.
How to apply an unmatched response orphan claim (type 2 orphan claim)
Here's how to apply an unmatched response orphan claim in ChiroUp:
We advise having two ChiroUp windows open at the same time to work orphan claims. The first window will be the Billing - Orphaned Claim Responses, and the second window will be the matching patient purchase.
1. Open Orphaned Claim Responses within the Billing Module in one window.
2. Locate the patient and service date in the orphan claim response.
3. In a second window on your computer, open ChiroUp and navigate to the corresponding patient purchase for that service date.
4. Confirm there is a policy associated with the corresponding purchase (note: sometimes the payor name may be listed under a different name but falls under the same insurer umbrella— verify this if needed).
5. If no policy is found on the corresponding purchase, add the correct policy to the purchase.
6. Return to the Billing - Orphaned Claim Responses window. On the orphaned claim response's Payor Dropdown, search for and select the payor that matches the policy on the purchase.
7. Click Associate Payor. The ERA will link if no errors are detected.
8. The orphaned response will then appear within the ERAs tab and will be ready for posting.