Introduction

ChARM BillerPro streamlines the claim generation process from an encounter. It has all the functionality that a biller needs to generate process claims. It also increases the efficiency of the Billers.

Multiple practices can be added to a BillerPro account for processing their claims.

Practices can be of three types.

• Practices not using ChARM EHR for their day-to-day activities
• Practices using ChARM EHR but not using Optum
• Practices using ChARM EHR and using Optum

Based on these practice categories, the workflow of processing claims will differ as given below.

Practices not using ChARM EHR

As a pre-requisite for claim generation, the following details need to be manually entered into the system for these practices.

• Service Facility
• Rendering Providers
• Billing Providers
• Pay to Address (If pay-to-address is different from the billing provider's address)

Claim Generation Flow

1. BillerPro User needs to receive chart notes to be claimed from practices.
2. Patient and Payer details need to be added into the system if they are not already available.
3. Generate a new claim.
4. Download PIF form or ANSI 1500 form (for electronic submission)
5. Submit to clearinghouse or payer.

RCM Dashboard access to Practices

• The BillerPro administrator can create a member with 'EHR User' as a role with practice's in-charge email id.
• BillerPro administrator should assign the corresponding practice to this member.
• BillerPro will send the registration email with the user-name and password to the registered practice's in-charge email.
• When the practice's in-charge logs into the RCM portal with this credential, RCM Dashboard and Reports of this practice will be visible to this user.

Practices using ChARM EHR but not using Optum

Since practices use ChARM EHR for their day-to-day activities, all the below details will generally flow from EHR to BillerPro

• Service Facility
• Rendering Providers
• Billing Providers
• Pay to Address (If pay-to-address is different from the billing provider's address)

Claim Generation Flow

1. Encounters/Chart notes will directly flow to the BillerPro.
2. Generate a claim from the chart notes
3. Download PIF form or ANSI 1500 form ( for electronic submission)
4. Submit to clearinghouse or payer

RCM Dashboard access to Practices

• Practice members (PracticeAdmin and Biller) can use their ChARM EHR user credentials to log into the RCM portal.
• RCM Dashboard and Reports of this practice will be visible to this user.

Practices using ChARM EHR and using Optum

Since the practices use ChARM EHR for their day-to-day activities, all the below mentioned details will generally flow from EHR to BillerPro

• Service Facility
• Rendering Providers
• Billing Providers
• Pay to Address (If pay-to-address is different from the billing provider's address)

Claim Generation Flow

1. Encounters/Chart notes will directly flow to the BillerPro.
2. Generate a claim from the chart notes
3. Submit claims electronically to Optum

RCM Dashboard access to Practices

• Practice members (PracticeAdmin and Biller) can use their ChARM EHR user credentials to log into the RCM portal.
• RCM Dashboard and Reports of this practice will be visible to this user